Disseminated Nocardia Farcinica Presenting as Diffused Pulmonary Nodular Infiltration in a Patient with Pemphigus Vulgaris-A Case Report

Abstract

Nocardia is a Gram-positive and weakly acid-fast stain-positive aerobic bacillus that is ubiquitous in the soil and water. It is an uncommon pathogen in humans, and found mostly in immunocompromised patients with variable etiologies. The acquisition of this infection is generally via the respiratory tract, and frequently involvs the subcutaneous tissue, lung, and central nervous system. There are some common predisposing factors associated with an immunocompromised status that cause nocardiosis. The image of pulmonary nocardiosis is variable and nonspecific, and the most common findings on chest radiography are: nodules/mass, cavitation, and consolidation/infiltrates. Disseminated nocardiosis with bacteremia is not common and may be fatal. We report a 57-year-old male non-smoker, who had pemphigus vulgaris and was receiving immuno-suppressive therapy, developed unexplained multiple pulmonary nodules 2 months later. Nocardia spp. bacteremia was identified, but responded poorly to trimethoprim-sulfamethoxazole (TMP/SMX) treatment. Finally, pulmonary nocardiosis was proved by open lung biopsy. Nocardia farcinica, a potentially multidrug resistant strain, was identified from positive blood culture. This is the 7(superscript th) case reported as pemphigus vulgaris complicated with human disseminated nocardiosis after therapy, from 1902 to 2005.