Abstract
Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.
Highlights
Nocardia infection was initially reported by Nocard, a French veterinarian in 1888 [1], who described an uncommon Grampositive bacterial infection caused by aerobic Actinomycetes
One would expect an increase in its prevalence due to immunosuppression and the increasing use of corticosteroids
We are able to demonstrate that the increased sensitivity of modern laboratory techniques enhanced our ability to detect nocardial infection even in a healthy individual
Summary
Nocardia infection was initially reported by Nocard, a French veterinarian in 1888 [1], who described an uncommon Grampositive bacterial infection caused by aerobic Actinomycetes. There are 85 identified species of Nocardia classified by using 16S rRNA gene sequence; approximately 25 species are associated with human infections. These include Nocardia asteroides complex (more than 50% human cases), N. brasiliensis, N. abscessus, N. cyriacigeorgica, N. farcinica, N. nova, N. transvalensis complex, N. nova complex, N. pseudobrasiliensis, Nocardia veteran, N. cerradoensis [2], and recently reported N. beijingensis [3,4,5,6,7,8]. The present report describes the clinical presentation of N. beijingensis as an endobronchial mass in an immunocompetent middle aged woman, without evidence of lung disease
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