Recurrent Empyema thoracic secondary to pulmonary nocardiosis in immunocompetent patients

• Main Authors: Abdul Hafidz, M.I (Author), Hadi, M.F (Author), Mohd Firdaus, M.A.-B (Author), Sukahri, S. (Author), Zainudin, L.D (Author)
• Format: Article
• Language: English
• Published: Hindawi Limited, 2020
• Subjects: adult; antibiotic agent; antibiotic therapy; arthralgia; Article; bacterial growth; bacterium culture; C reactive protein; clinical article; computer assisted tomography; cotrimoxazole; erythrocyte sedimentation rate; hemoptysis; human; human tissue; imipenem; lactate dehydrogenase; leukocytosis; lung tuberculosis; male; myalgia; Nocardia; nocardiosis; nonhuman; Paecilomyces; pleura empyema; pneumonia; recurrent disease; seborrheic dermatitis; skin biopsy; sputum culture; thorax drainage; thorax pain; thorax radiography; thrombocytosis; tissue culture; treatment duration; tuberculostatic agent; x-ray computed tomography
• Online Access: View Fulltext in Publisher; View in Scopus

 Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy. Copyright © 2020 Samshol Sukahri et al.