Nocardiosis in a patient with rheumatoid arthritis treated with rituximab and a summary of reported cases

Abstract

Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.

Figure 1

(A) Intraparenchymal speculated mass seen in the subpleural region at the left upper lobe before the lung biopsy. (B) Pectoralis major abscess with intraparenchimal lesion along the needling tract.

Figure 2

Summary of published Cases of Nocardiosis Post-Rituximab.