慢性阻塞性肺病合并支气管扩张患者的肺诺卡菌病

Q4 Medicine
Carmen Mira Palomino , Mónica Babiano Nodal , Beatriz Raboso Moreno
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引用次数: 0

摘要

肺诺卡菌病是一种罕见的机会性感染,由于其亚急性发作和非特异性临床和放射学表现而经常被误诊。我们报告了一位82岁的严重慢性阻塞性肺疾病(COPD)和双侧支气管扩张的男性,他表现为进行性呼吸困难和生产性咳嗽,对常规抗生素治疗无反应。≥104 CFU/mL支气管肺泡灌洗液中分离出肺炎诺卡菌。由于肾功能损害和电解质紊乱,停用甲氧苄啶-磺胺甲恶唑(TMP-SMX)的初始治疗;米诺环素在6个月后耐受良好,放射学完全消退。本病例强调了在COPD和支气管扩张患者中怀疑诺卡菌病的必要性,即使没有经典的免疫抑制,特别是在反复使用皮质类固醇治疗后。早期诊断、与微生物实验室沟通和靶向抗生素治疗是改善预后的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pulmonary Nocardiosis in a Patient With COPD and Bronchiectasis
Pulmonary nocardiosis is a rare opportunistic infection, often misdiagnosed due to its subacute onset and non-specific clinical and radiological findings. We report an 82-year-old man with severe chronic obstructive pulmonary disease (COPD) and bilateral bronchiectasis, who presented with progressive dyspnoea and productive cough unresponsive to conventional antibiotic therapy. Nocardia pneumoniae was isolated from bronchoalveolar lavage at ≥104 CFU/mL. Initial treatment with trimethoprim–sulfamethoxazole (TMP–SMX) was discontinued due to renal impairment and electrolyte disturbances; minocycline was initiated with good tolerance and complete radiological resolution after six months. This case highlights the need to suspect nocardiosis in COPD and bronchiectasis patients, even without classical immunosuppression, particularly after repeated corticosteroid courses. Early diagnosis, communication with the microbiology laboratory, and targeted antibiotic therapy are key to improving outcomes.
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来源期刊
Open Respiratory Archives
Open Respiratory Archives Medicine-Pulmonary and Respiratory Medicine
CiteScore
1.10
自引率
0.00%
发文量
58
审稿时长
51 days
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