Khan Sandus, Ignatowicz Aleksandra, Balaji Nivedha, Chew Christopher R, Mihilli Aleksandros, Patel Urvesh
Internal Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
Cureus. 2024 Feb 22;16(2):e54722. doi: 10.7759/cureus.54722. eCollection 2024 Feb.
Severe, refractory asthma requires a combination of multiple maintenance inhalers and medications including high-dose inhaled corticosteroids and immunomodulators to achieve control of symptoms. The use of inhaled corticosteroids, however, increases the susceptibility of opportunistic bacterial infections, such as , resulting in pulmonary nocardiosis. This case describes a 46-year-old patient with a history of severe, refractory asthma who presented with progressively worsening asthma exacerbation symptoms. She was treated with immunomodulators, high-dose inhaled corticosteroids and oral steroids, and several courses of antibiotics. CT imaging revealed bibasilar peri-bronchial thickening and tree-in-bud nodularity in the right lower lobe. Pulmonary cultures collected from bronchoscopy grew complex. This was a rare case of persistent asthma exacerbation by complex bronchopulmonary infection. Broad differentials should be considered in patients with severe, refractory asthma who were previously controlled and were found to fail treatment therapies. Immunocompromised patients with chronic lung disease are at higher risk of severe infection with disseminated nocardiosis. These patients have a higher mortality and morbidity risk if early diagnosis of pulmonary nocardiosis does not occur.
重度难治性哮喘需要联合使用多种维持吸入器和药物，包括高剂量吸入性糖皮质激素和免疫调节剂，以控制症状。然而，吸入性糖皮质激素的使用会增加机会性细菌感染的易感性，如导致肺诺卡菌病。本病例描述了一名46岁有重度难治性哮喘病史的患者，其哮喘急性加重症状逐渐恶化。她接受了免疫调节剂、高剂量吸入性糖皮质激素和口服类固醇治疗，以及多个疗程的抗生素治疗。CT成像显示双肺基底段支气管周围增厚以及右下叶的树芽状结节。支气管镜检查采集的肺组织培养物培养出诺卡菌属复合体。这是一例由诺卡菌属复合体支气管肺感染导致的持续性哮喘急性加重罕见病例。对于先前病情得到控制但治疗失败的重度难治性哮喘患者，应考虑广泛鉴别诊断。患有慢性肺病免疫功能低下的患者发生播散性诺卡菌病严重感染的风险更高。如果不能早期诊断肺诺卡菌病，这些患者死亡和发病的风险会更高。
