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Review
. 2010 Sep 29:2010:bcr1120092421.
doi: 10.1136/bcr.11.2009.2421.

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

C S Ngiu  1 , M S Mohamed Said, P Periyasamy, S F Low
Affiliations
Review

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

C S Ngiu et al. BMJ Case Rep. .

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.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
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
Figure 2
Summary of published Cases of Nocardiosis Post-Rituximab.
See this image and copyright information in PMC

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