Uncommon finding in a pulmonary graft versus host disease: A first report of Tsukamurella pneumonia in a pulmonary graft-versus-host disease

Abstract

A 64-year-old woman presented to Our Department with 2 weeks history of fever and cough. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of Tsukamurella pneumonia; Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach. Tsukamurella spp. is an obligate aerobic, Gram-positive, weakly acid-fast, non-motile bacillus that belongs to the order Actinomycetales. Pneumonia caused by Tsukamurella is exceedingly rare, and only few cases are reported in the literature. Our aim is to evidence the paramount importance of Multidisciplinary team discussion in deciding the most appropriate diagnostic is of and therapeutical strategy.

Keywords: Gene sequencing; Graft versus host disease; Immunocompromised; Multidisciplinary team discussion; Pneumonia; Tsukamurella.

Fig. 1

Right upper lobe cavitation in chest X-ray antero-posterior view.

Fig. 2

Right upper lobe cavitation with bilateral nodular pattern in chest CT scan axial view.

Fig. 3

Bronchoalveolar lavage cultures were positive in Chocolate PolyViteX agar.

Fig. 4

Resolution of the cavitary area in the right upper lobe in chest CT scan axial view.