Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2021; 9(23): 6824-6831
Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6824
Nocardiosis with diffuse involvement of the pleura: A case report
Ping Wang, Mao-Li Yi, Cheng-Zhou Zhang
Ping Wang, Cheng-Zhou Zhang, Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
Mao-Li Yi, Department of Laboratory Medicine, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
Author contributions: Wang P and Yi ML contributed equally to this work; Wang P drafted the manuscript; Yi ML provided guidance for the case diagnosis and helped to draft the manuscript; Zhang CZ was responsible for the literature review and revised the article for important intellectual content; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Zhou Zhang, MD, Chief Doctor, Department of Radiology, Yantai Yuhuangding Hospital, No. 20 Yudong Road, Zhifu District, Yantai 264000, Shandong Province, China. chzh_zhang@163.com
Received: January 31, 2021
Peer-review started: January 31, 2021
First decision: March 11, 2021
Revised: March 31, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: August 16, 2021
Processing time: 186 Days and 1.7 Hours
Abstract
BACKGROUND

Nocardiosis is an uncommon infection that usually occurs in immunocompromised patients, and the pulmonary system is the most common site. We report an uncommon case of nocardiosis with diffuse involvement of the pleura, which presented as multiple localized nodular or hillock lesions on computed tomography (CT) with local chest wall infiltration.

CASE SUMMARY

A 54-year-old woman was referred to our hospital due to cough and fever for 20 d. She had a history of nephrotic syndrome for 7 mo and was given prednisone (60 mg/d) 6 mo previously. The hormone was then gradually reduced to the current dose of 25 mg/d. Chest CT showed many nodular or hillock lesions in the right pleura, mediastinum, and interlobar fissure areas. On the lower layer, one lesion infiltrated the chest wall. She was treated with piperacillin sodium and sulbactam sodium, but the therapeutic effect was not good. In this regard, ultrasound-guided local infiltration anesthesia was further conducted for perihepatic hydrops drainage to improve diagnostic accuracy. Puncture fluid culture isolated Nocardia species, confirming the diagnosis of nocardiosis. Subtype Nocardia farcinica was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiotic treatment was switched to trimethoprim/sulfamethoxazole and imipenem. After 8 d of treatment, the patient was discharged from the hospital with improved condition, and she has been recurrence-free for 2 years.

CONCLUSION

This report illustrates that nocardiosis should be suspected when clinicians encounter patients who are immunocompromised and have diffuse involvement of the pleura.

Keywords: Nocardiosis; Lung; Pleura; Computed tomography; Case report

Core Tip: Nocardiosis is an uncommon subacute or chronic suppurative infection that usually occurs in immunocompromised patients. The pathological manifestations of nocardiosis are usually granulomas or abscesses. This case of nocardiosis exhibited diffuse involvement of the pleura and presented as multiple localized nodular or hillock shadows in the pleura, mediastinum, and interlobar fissure areas on computed tomography, which differs from simple pleural effusion or general bacterial infection.