An unexpected case of broncholithiasis secondary to pulmonary nocardiosis

Abstract

Persistent productive cough despite appropriate treatment warrants consideration of flexible bronchoscopy to obtain bronchial specimens for culture. Endobronchial examination of airways may reveal signs of infection in the form of purulent secretions, sputum plugs or in this case, an unexpected finding of a calcified broncholithiasis secondary to Nocardia infection.

Keywords: broncholithiasis; endobronchial nocardiosis; infection; pulmonary nocardiosis.

FIGURE 1

High‐resolution computed tomography chest demonstrating bronchiectasis, tree‐in‐bud changes in the right lower lobe and patchy ground glass changes and focal consolidation in the left upper lobe in coronal (A) and axial (B, C) views. Bronchoscopic view of calcified bronchiolith (see black arrow) adjacent to the lingula stump (D). Gram stain of bronchoalveolar lavage demonstrating hyphae (see white arrow) (E). Modified Ziehl Nielson stain demonstrating filamentous organisms consistent with Nocardia species (see white arrow) (F).