Pulmonary nocardiosis revisited: A case series

Abstract

Pulmonary nocardiosis is a rising bacterial infection, with a high propensity for misdiagnosis. On account of a paucity of prospective studies, there is limited understanding on various aspects of its diagnosis and treatment. We present three patients with pulmonary nocardiosis, with emphasis on the predisposing factors, variable disease course, and treatment issues. There is a need to understand the basis of these discrepancies so as to rationalize the management of this potentially fatal infection.

Keywords: Infection; nocardiosis; pulmonary.

Figure 1

(a) X-ray chest, PA view, showing non-homogenous opacity involving all zones on the right side and in the left para-hilar region; (b) Photomicrograph showing Nocardia species (black arrow) stained with modified Ziehl Neelsen stain (under ×100); (c) Axial cut section CT thorax showing a right-sided, loculated, hydropneumothorax and basilar necrotizing consolidation; (d) X-ray chest PA view, showing clearing of shadows with residual fibrotic scarring over the left lung field

Figure 2

Two axial cut sections of the CT thorax, with contrast showing patchy areas of necrotizing consolidation and few cavitating nodules

Figure 3

(a) X-ray chest, PA view, showing homogenous opacity involving all zones over the right hemothorax, as well as, over the mid and lower zones on the left side; (b) Axial section of the CT thorax below the carina showing three areas of mass-like consolidations, involving the bilateral hemothorax; (c) X-ray chest, PA view, showing marked resolution of the opacities with residual fibrosis