Case Report: Pulmonary Nocardiosis in a Patient with Chronic Obstructive Pulmonary Disease and Receiving Corticosteroid Treatment due to Nephrotic Syndrome

Abstract

 Introduction: Nocardia spp. belong to Actinomycetes family and usually found in soil. They show variation in acid fast stain. Microscobic examination reveals Gram positive filamentous bacilli. Nocardiosis, is a rare clinical situation caused by Nocardia species and takes place especially in immunosuppressed individuals. In our case report we aimed to present pulmonary nocardiosis in a patient receiving corticosteroid treatment due to nephrotic syndrome and also accompanying chronic obstructive pulmonary disease. Case Presentation: 53 year old male patient was admitted to the Chest Diseases outpatient clinic with fever, sputum and cough complaints. The patient had a previous story of nephrotic syndrome and chronic obstructive pulmonary disease and receiving corticosteroid treatment. Thorax CT image showed a 13 cm cavitary lesion at the lower lobe of the right lung, and 21 mm lesion neighboring to the other lesion. Fibrotic structure was detected on both hilus of the lung. This was evaluated as a sequela of infection. The patient underwent flexible bronchoscopy and respiratory tract specimens (bronchoalveolar lavage, bronchial lavage and sputum) were sent to the Microbiology Laboratory. The Gram stain showed filamentous Gram positive bacilli and on the fourth day of incubation Nocardia spp was reported. The patient was administered trimethoprim sulfamethoxazole treatment and recovered. Discussion: Pulmonary nocardiosis is a rare disease. The importance of this infectious pathogen has increased due to recent increase immunosuppressive treatment modalities, HIV infection, and organ transplantation. The clinical and radiological symptoms are nonspecific and because of this microbiological methods are important in diagnosis of nocardiosis. Consecutive examination of clinical material showing the typical microscopic appearance in these patients should draw the attention of the clinician to this pathogen and treatment is needed to be done accordingly