Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1175-1181
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1175
Nocardia cyriacigeorgica infection in a patient with repeated fever and CD4+ T cell deficiency: A case report
Xin Hong, You-Qi Ji, Meng-Yuan Chen, Xiao-Yu Gou, Yu-Mei Ge
Xin Hong, Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou 310014, Zhejiang Province, China
You-Qi Ji, School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Meng-Yuan Chen, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Xiao-Yu Gou, Yu-Mei Ge, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
Author contributions: Hong X, Ji YQ, Chen MY, and Gou XY collect the patient clinical information and analysed the data; Ge YM drawn the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Written and informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
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: Yu-Mei Ge, PhD, Doctor, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Gongshu District, Hangzhou 310014, Zhejiang Province, China. 11218070@zju.edu.cn
Received: November 12, 2022
Peer-review started: November 12, 2022
First decision: December 26, 2022
Revised: January 7, 2023
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 16, 2023
Processing time: 93 Days and 21.8 Hours
Abstract
BACKGROUND

Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms, but the treatment and anti-infective medication are completely different. Here, we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica (N. cyriacigeorgica), which was misdiagnosed as community-acquired pneumonia (CAP) with repeated fever.

CASE SUMMARY

A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months. After the anti-infection treatment failed in the local hospital, the patient came to our hospital for further treatment. Enhanced computed tomography showed multiple patchy, nodular and strip-shaped high-density shadows in both lungs. A routine haematological examination was performed and showed abnormalities in CD19+ B cells and CD4+ T cells. Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope, which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N. cyriacigeorgica. The patient's condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.

CONCLUSION

The antibiotic treatment of Nocardia pneumonia is different from that of common CAP. Attention should be given to the pathogenic examination results of patients with recurrent fever. Nocardia pneumonia is an opportunistic infection. Patients with CD4+ T-cell deficiency should be aware of Nocardia infection.

Keywords: Nocardia pneumonia; Nocardia cyriacigeorgica; Matrix-assisted laser desorption ionization-time of flight mass spectrometry; Infection; Lung; CD4+T-cell; Case report

Core Tip: Patients with CD4+ T-cell deficiency should be aware of Nocardia infection. Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms, but the treatment and anti-infective medication are completely different. Here, we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica (N. cyriacigeorgica), which was misdiagnosed as community-acquired pneumonia with repeated fever. We identified the pathogen by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The patient used compound sulfamethoxazole tablets (0.96 g) three times a day. After one week of treatment, the infection index returned to normal, the patient's condition improved significantly, and she was discharged.