Abstract
Introduction: Nocardia exalbida is an uncommon Nocardia sp., first described in 2006. We report a case of pulmonary infection due to this organism, which became evident after treatment of antecedent pneumococcal pneumonia. Case presentation: A 68-year-old man was hospitalized because of pneumococcal pneumonia. Although his symptoms improved immediately after administration of anti-pneumococcal antibiotics, patchy opacity on the chest X-ray remained and pyrexia recurred. Administration of trimethoprim/sulfamethoxazole, given after seropositivity against human immunodeficiency virus type 1 was confirmed and Nocardia-like organisms were detected from the sputa, completely resolved his symptoms. The recovered organism was identified as N. exalbida by comparison of 16S rRNA gene sequences. Conclusion: To the best of our knowledge, only six other cases of N. exalbida infection have been described. Most of these cases were reported from Japan, suggesting that the organism is more prevalent in this country than in other areas. The present case also highlights that underlying nocardiosis should be considered when an immunocompromised patient with acute bacterial pneumonia demonstrates refractory respiratory manifestations, despite receiving appropriate treatments.
Highlights
Nocardia exalbida is an uncommon Nocardia sp., first described in 2006
Only a few cases of N. exalbida infection have been described in the Abbreviations: human immunodeficiency virus type 1 (HIV-1), Human immunodeficiency virus type 1; TMP/ SMX, trimethoprim/sulfamethoxazole
We report a case of pulmonary infection caused by N. exalbida in a human immunodeficiency virus type 1 (HIV-1)-infected patient, which became evident after treatment of antecedent pneumococcal pneumonia
Summary
Members of the genus Nocardia, a group of aerobic actinomycetes forming Gram-positive branching filaments, are widely found in the environment, including in soil and water. Only a few cases of N. exalbida infection have been described in the Abbreviations: HIV-1, Human immunodeficiency virus type 1; TMP/ SMX, trimethoprim/sulfamethoxazole. 12 mg (kg body weight) for the TMP component) on day 21 because Gram-positive, acid-fast (with the modified Kinyoun method) branching filamentous bacteria, suggesting Nocardia spp., were detected from the sputum but was reduced to three tablets on day 27 because severe appetite loss emerged. Thereafter, his productive cough and intermittent fever disappeared and the size of the patchy opacity on the chest X-ray diminished (Fig. 1c). Iida et al (2006) Iida et al (2006) Mizota et al (2007) Ono et al (2008) Imai et al (2011) Milman et al (2011)
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