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A Case of Disseminated Nocardiosis in an Immunocompetent Host, with Prompt Diagnosis by Gram Stain from a Lung Abscess
Department of Respiratory Medicine, Ichinomiyanishi Hospital
Hiroyuki FUJIWARA, Masanori NAKANISHI & Kenichi YAMAKI
(Received July 18, 2017)
(Accepted October 27, 2017)
Key words: disseminated nocardiosis, percutaneous lung biopsy, gram stain

A 79-year-old female with a history of liver cirrhosis was admitted to our hospital with dyspnea on exertion and right hip pain. Her chest CT showed a combination of pulmonary infiltration and multiple nodules and her head MRI showed 3 nodules in the cerebrum. We obtained bacteriological specimens from the hip abscess and lung abscess. Gram staining showed the presence of branching gram positive rods, which suggested Nocardia. We administered sulfamethoxazole - trimethoprim and imipenem/cilastatin, and her condition and radiology findings promptly improved. Nocardiosis is commonly seen in immunosuppressed patients but is also seen in the immunocompetent. Malignancy, HIV infection, diabetes mellitus and chronic pulmonary disease are common underlying diseases and some report the presence of nocardiosis together with liver cirrhosis. Disseminated nocardiosis has high mortality and it is important to make an initial assessment appropriately and to administrate proper antibiotic agents as early as possible. The gram-stain is an effective way to evaluate nocardia infection because a long time is usually needed to obtain the result of bacterial cultures.

[ Kansenshogaku Zasshi 92: 76-79, 2018 ]

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