PDF(Pubmed)
Abstract：
Severe, refractory asthma requires a combination of multiple maintenance inhalers and medications including high-dose inhaled corticosteroids and immunomodulators to achieve control of symptoms. The use of inhaled corticosteroids, however, increases the susceptibility of opportunistic bacterial infections, such as Nocardia, resulting in pulmonary nocardiosis. This case describes a 46-year-old patient with a history of severe, refractory asthma who presented with progressively worsening asthma exacerbation symptoms. She was treated with immunomodulators, high-dose inhaled corticosteroids and oral steroids, and several courses of antibiotics. CT imaging revealed bibasilar peri-bronchial thickening and tree-in-bud nodularity in the right lower lobe. Pulmonary cultures collected from bronchoscopy grew Nocardia nova complex. This was a rare case of persistent asthma exacerbation by N. nova complex bronchopulmonary infection. Broad differentials should be considered in patients with severe, refractory asthma who were previously controlled and were found to fail treatment therapies. Immunocompromised patients with chronic lung disease are at higher risk of severe infection with disseminated nocardiosis. These patients have a higher mortality and morbidity risk if early diagnosis of pulmonary nocardiosis does not occur.
摘要：
严重,难治性哮喘需要多种维持吸入剂和药物的组合,包括大剂量吸入糖皮质激素和免疫调节剂,以实现症状的控制.吸入性皮质类固醇的使用，然而,增加机会性细菌感染的易感性，比如诺卡氏菌,导致肺诺卡心症。该病例描述了一名46岁的患者，有严重的病史，出现逐渐恶化的哮喘加重症状的难治性哮喘。她接受了免疫调节剂治疗,大剂量吸入皮质类固醇和口服类固醇，和几个疗程的抗生素。CT成像显示双基底周围支气管增厚和右下叶的树芽结节。从支气管镜检查收集的肺培养物生长了诺卡氏菌新星复合物。这是一例罕见的由N.nova复合支气管肺感染引起的持续哮喘恶化病例。严重的患者应考虑广泛的差异，以前得到控制并发现治疗失败的难治性哮喘。免疫功能低下的慢性肺病患者发生播散性诺卡尼病的严重感染的风险更高。如果未早期诊断为肺诺卡尼病，这些患者的死亡率和发病率较高。
