Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7920
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
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.
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.
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.