Concomitant pulmonary aspergillosis and nocardiosis in a patient with chronic granulomatous disease of childhood.

Chronic granulomatous disease is characterized by recurrent infections with microorganisms which produce catalase, an enzyme that detoxifies endogenous or exogenous hydrogen peroxide to water and oxygen. Among 245 patients with CGD reviewed by Cohen et al, (7)20.4% had a history of fungal infection. The frequency with which fungal infections occur in patients with CGD emphasizes the importance of the phagocyte in defense against these pathogens. Our case of concomitant pulmonary aspergillosis and nocardiosis in a 15-year-old boy with CGD who had previous infections with both of these organisms illustrates several important points: (1) Aggressive diagnostic approaches (eg, open lung biopsy) are often required to make the diagnosis of fungal infections in patients with CGD; (2) patients with CGD can have multiple simultaneous infections with catalase-positive organisms; and (3) acute infections with Aspergillus or Nocardia do not provide lasting immunity in patients with CGD.