Qi DD, Zhuang Y, Chen Y, Guo JJ, Zhang Z, Gu Y. Interstitial pneumonia combined with nocardia cyriacigeorgica infection: A case report. World J Clin Cases 2023; 11(32): 7920-7925 [PMID: 38073689 DOI: 10.12998/wjcc.v11.i32.7920]
Corresponding Author of This Article
Yan Gu, MD, Doctor, Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1-1, Zhongfu Road, Gulou District, Jiangsu Province, Nanjing 210003, China. guyan703@foxmail.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2023; 11(32): 7920-7925 Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7920
Interstitial pneumonia combined with nocardia cyriacigeorgica infection: A case report
Dao-Da Qi, Yi Zhuang, Yang Chen, Jing-Jing Guo, Ze Zhang, Yan Gu
Dao-Da Qi, Yang Chen, Jing-Jing Guo, Ze Zhang, Yan Gu, Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
Yi Zhuang, Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210006, Jiangsu Province, China
Author contributions: All authors examined the patient; Zhuang Y and Gu Y participated in the discussion for the treatment and gave important suggestions; Qi DD and Chen Y drafted the manuscript; All authors critically revised the paper for important intellectual content, and all authors approved the final version of the manuscript.
Supported byMedical Science and Technology Development Foundation, Nanjing Department of Health, No. YKK20067.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare no conflict of interest associated with this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Gu, MD, Doctor, Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1-1, Zhongfu Road, Gulou District, Jiangsu Province, Nanjing 210003, China. guyan703@foxmail.com
Received: September 26, 2023 Peer-review started: September 26, 2023 First decision: October 17, 2023 Revised: October 25, 2023 Accepted: November 2, 2023 Article in press: November 2, 2023 Published online: November 16, 2023 Processing time: 50 Days and 14.4 Hours
Abstract
BACKGROUND
Nocardia infection is a relatively uncommon disease, with no reports among patients with interstitial pneumonia. Due to its atypical clinical symptoms and chest computed tomography (CT) findings and the frequent yielding of negative results by conventional cultures, it poses challenges for timely diagnosis and treatment.
CASE SUMMARY
A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite, accompanied by a 2-wk long duration of headaches. She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine. Chest CT revealed the presence of newly developed round nodules. The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing (mNGS) performed on bronchoalveolar lavage fluid. Targeted anti-infection therapy was initiated, resulting in symptom improvement and radiological resolution, further validating the mNGS results.
CONCLUSION
Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients. Its clinical and radiological manifestations lack specificity, but mNGS can aid in rapidly obtaining pathogenic information. Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.
Core Tip: In patients with interstitial pneumonia receiving oral steroids and immunosuppressants, the presence of new nodules, masses, or cavitary lesions should raise suspicion of concurrent Nocardia infection. In addition to routine examinations and tests, metagenomic next-generation sequencing can provide rapid pathogen identification, facilitating early targeted antimicrobial therapy and ultimately improving patient outcomes.
