Najafizadeh Maedeh, Kourkinejad Gharaei Fatemeh, Manouchehri Ardekani Reza, Rafiyan Mahdi
Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran.
Student Research Committee, Kashan University of Medical Sciences, Pezeshk Blvd. - Qotb Blvd, Kashan, Islamic Republic of Iran.
J Med Case Rep. 2025 Jan 21;19(1):29. doi: 10.1186/s13256-025-05037-0.
Nocardia infections are rare infections in immunocompetent patients and occur mostly in immunocompromised individuals. Usually, nocardia affects skin, brain, and lungs, but in disseminated forms, which occurred mostly in immunocompromised patients, it can involve every organ. Nocardia sinusitis is extremely rare as our searches returned only a very few related studies.
In this case report, we present, for the first time, a 55-year-old Iranian male patient diagnosed with chronic lymphocytic leukemia who was receiving chemotherapeutic drugs and developed a fever. Further laboratory tests and imaging revealed pansinusitis. Following rhinoendoscopy, the sinus mucosal biopsy pathology report showed sever inflammation accompanied by aggregation of filamentous thin-walled bacteria. The patient was treated with co-trimoxazole and meropenem. Following good clinical improvement the patient was discharged and advised to continue oral co-trimoxazole for 3 months.
This case highlights that patients with febrile neutropenia should be assessed for rare infectious disease etiologies, especially those with chronic lymphocytic leukemia, as they have humeral immunodeficiency, and in the later stages of the disease, cellular immunodeficiency may also be involved. Therefore, a multisystem evaluation of patients with febrile neutropenia is necessary, particulary when no obvious source is identified in initial surveys, to uncover rare etiologies.
诺卡菌感染在免疫功能正常的患者中较为罕见，主要发生在免疫功能低下的个体中。通常，诺卡菌会影响皮肤、大脑和肺部，但在播散性感染中（大多发生在免疫功能低下的患者），它可累及各个器官。诺卡菌性鼻窦炎极为罕见，因为我们的检索仅返回了极少数相关研究。
在本病例报告中，我们首次介绍了一名55岁的伊朗男性患者，他被诊断患有慢性淋巴细胞白血病，正在接受化疗药物治疗，并出现发热症状。进一步的实验室检查和影像学检查显示全鼻窦炎。鼻内镜检查后，鼻窦黏膜活检病理报告显示严重炎症伴丝状薄壁细菌聚集。患者接受了复方新诺明和美罗培南治疗。临床症状明显改善后，患者出院，并被建议继续口服复方新诺明3个月。
本病例强调，对于发热性中性粒细胞减少症患者，尤其是患有慢性淋巴细胞白血病的患者，应评估其是否存在罕见的感染性疾病病因，因为他们存在体液免疫缺陷，在疾病后期可能还涉及细胞免疫缺陷。因此，对发热性中性粒细胞减少症患者进行多系统评估是必要的，特别是在初始检查未发现明显病因时，以发现罕见病因。
