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Case Reports
. 2009 Fall;20(3):e103-6.
doi: 10.1155/2009/181750.

Nocardia farcinica lung abscess presenting in the context of advanced HIV infection: Spontaneous resolution in response to highly active antiretroviral therapy alone

Arienne S King  1 , Jose G Castro, Gordon Ck Dow
Affiliations
Case Reports

Nocardia farcinica lung abscess presenting in the context of advanced HIV infection: Spontaneous resolution in response to highly active antiretroviral therapy alone

Arienne S King et al. Can J Infect Dis Med Microbiol. 2009 Fall.

Abstract
in English, French

A 43-year-old man, known to be HIV-positive, presented with a six-week history of symptoms including cough, hemoptysis, anterior chest pain, fever and wasting. His CD4 cell count was 46 cells/muL, and his chest x-ray showed a cavitating lesion in the left upper lobe. Sputum culture was positive for Nocardia farcinica. His infection resolved following initiation of antiretroviral therapy. Nocardia is an uncommon opportunistic pathogen in patients with HIV infection and is usually associated with advanced CD4 depletion, cavitary pneumonia, metastatic infection and high mortality. The impact of antiretroviral therapy on Nocardia infection in the setting of HIV has not been clearly elucidated. The current report is the first to present a case in which a complete clinical cure of Nocardia pneumonia has been documented, primarily in response to highly active antiretroviral therapy alone.

Un homme de 43 ans qu’on savait séropositif au VIH a consulté en raison de symptômes de toux, d’hémoptysie, de douleurs thoraciques antérieures, de fièvre et de fonte musculaire. Sa numération de lymphocytes T CD4 était de 46 cellules/μL, et sa radiographie thoracique a révélé une lésion pulmonaire cavitaire du lobe supérieur gauche. Les cultures d’expectoration étaient positives au Nocardia farcinica. Son infection s’est résorbée après une antivirothérapie. Le Nocardia est un pathogène opportuniste peu courant chez les patients atteints d’une infection par le VIH et s’associe généralement à une déplétion avancée des lymphocytes T CD4, à une pneumonie cavitaire, à une infection métastatique et à un fort taux de mortalité. Les répercussions de l’antivirothérapie sur l’infection à Nocardia en présence d’un VIH ne sont pas clairement établies. Le présent rapport est le premier à présenter un cas qui documente la guérison clinique complète de la pneumonie à Nocardia, obtenue principalement grâce à une antirétrovirothérapie hautement active.

Keywords: AIDS; Cavitary lung disease; Nocardia farcinica.

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Figures

Figure 1)
Figure 1)
Chest x-ray on admission to hospital. Note the infiltrate in the left upper lobe
Figure 2)
Figure 2)
Computed tomography scan of chest at admission showing multiple thick-walled cavities within left upper lobe pneumonic infiltrate
Figure 3)
Figure 3)
Subsequent chest x-ray obtained five months after discharge from hospital. Note the resolution of the cavitating lesion in the left upper lobe
See this image and copyright information in PMC

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