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Nocardial hydropneumothorax.

K Gowrinath¹, Swati Das, Mary Ranjitham

¹Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, PorurChennai, India.

The Indian Journal of Chest Diseases & Allied Sciences

|February 12, 2004

Summary

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See all related articles

Nocardiosis can affect the pleura, causing hydropneumothorax, especially in individuals with diabetes. Treatment with antibiotics and drainage improved the patient

Area of Science:

Medical Mycology
Pulmonary Medicine
Infectious Diseases

Background:

Nocardiosis, a rare bacterial infection, can manifest in various forms, with pleural involvement being infrequently documented, particularly in the Indian subcontinent.
Diabetes mellitus is a known risk factor that can predispose individuals to opportunistic infections like nocardiosis.

Observation:

A case of hydropneumothorax, a condition involving both air and fluid in the pleural space, was diagnosed in a patient with diabetes mellitus.
The causative agent was identified as Nocardia asteroides, a bacterium rarely implicated in pleural infections.

Findings:

Management involved tube thoracostomy for pleural fluid drainage and a seven-month course of trimethoprim-sulphamethoxazole.
While the treatment successfully prevented fluid reaccumulation and improved the patient's general condition, complete lung expansion was not achieved.

Related Experiment Videos

This case highlights the challenges in managing complex nocardial infections and the potential limitations of standard therapeutic approaches.

Implications:

The findings suggest that persistent pleural effusions in nocardiosis may require prolonged treatment and may not always result in full lung recovery.
Bronchoscopy is proposed as a valuable diagnostic tool for pulmonary nocardiosis when repeated sputum examinations yield negative results.
This case underscores the importance of considering nocardiosis in the differential diagnosis of hydropneumothorax, especially in immunocompromised patients.