Tuberc Respir Dis.  2010 Dec;69(6):469-473.

A Case of Pneumonia with Septic Shock Due to Nocardia farcinia in Liver Transplant Patient

Affiliations
  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. pms70@yuhs.ac
  • 2The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.

Keyword

Nocardia; Pneumonia; Shock; Sepsis, Liver Transplantation

MeSH Terms

Abscess
Actinobacteria
Anti-Bacterial Agents
Carcinoma, Hepatocellular
Central Nervous System
Hepatitis B, Chronic
Humans
Hypotension
Hypothermia
Liver
Liver Transplantation
Lung
Male
Middle Aged
Nocardia
Nocardia Infections
Opportunistic Infections
Pneumonia
Pneumonia, Bacterial
Sepsis
Shock
Shock, Septic
Skin
Tachypnea
Thorax
Transplants
Anti-Bacterial Agents

Figure

  • Figure 1 Initial chest X-ray showed air containing consolidation and abscess at left lung and multiple small nodules at both lungs.

  • Figure 2 The chest computed tomography revealed necrosis and volume expansion of left upper lobe. Several multiple nodules appeared at both lungs.

  • Figure 3 (A) Colonial morphology of gram positive bacilli on a blood agar plate. (B) Gram-positive branched rods are observed (H&E stain, ×1,000).

  • Figure 4 Last chest X-ray showed progressive consolidation at both lower lungs.


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