Tuberc Respir Dis.  2016 Apr;79(2):101-103. 10.4046/trd.2016.79.2.101.

A Case of Nocardia farcinica Pneumonia and Mediastinitis in an Immunocompetent Patient

• Kim J
• Kang M
• Kim J
• Jung S
• Park J
• Lee D
• Yoon H

• KMID: 2320773
• DOI: http://doi.org/10.4046/trd.2016.79.2.101

Abstract

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.

Keyword

Nocardia; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

MeSH Terms

Diagnosis
Dyspnea
Humans
Hypertension
Immunocompromised Host
Male
Mediastinitis*
Middle Aged
Nocardia Infections
Nocardia*
Pneumonia*
Soil
Thoracic Wall
Soil

Figure

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  Figure 1 Computed tomography scan shows about 4 cm, peripheral enhancing, low density, probably necrotic, lobulating margin mass at right anterior cardiophrenic angle (arrow) and bilateral pleural effusion.

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  Figure 2 H&E stain showed a fibrous combination of acute and chronic inflammation without any malignant cells (×200).

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