肺诺卡氏菌病(PN)是由诺卡氏菌引起的一种罕见但严重的疾病。尽管传统描述为机会性感染,最近在免疫功能正常的患者中也报道了肺诺卡病的病例报告和病例系列,特别是在患有慢性肺疾病如晚期慢性阻塞性肺疾病(COPD)的人群中。PN的特征在于非特异性症状和放射学发现;细菌学培养可能很困难。由于上述原因,PN的诊断具有挑战性,有时会导致结核病的误诊。我们报告了一名75岁男性COPD患者中的一个有趣的PN病例。他抱怨有3个月的疲劳史,晚上体温上升,盗汗,无法解释的体重减轻5公斤,呼吸困难恶化,咳嗽和粘液脓性痰。胸部X线检查显示根尖和锁骨下区域两侧有多个结节,并伴有空洞。在三个痰样本中鉴定出具有100%同一性的诺卡氏菌。由于患者从未接受过全身和/或吸入类固醇治疗,并且没有导致免疫抑制的呼吸衰竭和合并症,可以想象,在这个有免疫能力的病人身上,COPD可能是PN的独立危险因素.危险因素,临床表现,射线照相结果,COPD中PN病例的鉴别诊断和文献复习,指出异同,也有描述。
Pulmonary nocardiosis (PN) is a rare but severe disease caused by Nocardia spp. Despite the traditional description as opportunistic infection, case reports and case series of pulmonary nocardiosis have recently been reported in immunocompetent patients too, in particular among people with chronic pulmonary diseases such as advanced Chronic Obstructive Pulmonary Disease (COPD). PN is characterized by non-specific symptoms and radiological findings; bacteriological culture can be difficult. For the reasons above, diagnosis of PN is challenging, sometimes resulting in a misdiagnosis of tuberculosis. We report an interesting case of PN in a 75-year-old male with COPD. He complained a 3-months history of fatigue, evening rise in body temperature, night sweats, unexplained weight loss of 5 kg, worsening dyspnea, cough and mucopurulent sputum. The chest X-ray showed multiple nodules with cavitations bilaterally in the apical and subclavian regions. Nocardia cyriacigeorgica with 100% identity was identified in three sputum samples. Since the patient has never undergone a systemic and/or inhaled steroid therapy, and has no respiratory failure and comorbidities entailing immunodepression, it is conceivable that, in this immunocompetent patient, the COPD could represent an isolated risk factor for PN. Risk factors, clinical presentations, radiographic findings, differential diagnosis and review of the literature of PN cases in COPD, pointing out the similarities and differences, are also described.