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Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases
03:22

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases

Published on: March 1, 2024

[Unusual infection with pulmonary round foci obtained through "hay packs"]

A Pfosser1, P Raake, C Reithmann

  • 1Medizinische Klinik I der Universität München, Klinikum Grosshadern. achim.pfosser@med.uni-muenchen.de

Der Internist
|September 1, 2005
PubMed

Insights

A severe pneumonia case in a steroid-treated patient was initially misdiagnosed. Delayed diagnosis of pulmonary nocardiosis, caused by Nocardia farcinica, led to critical illness but was successfully treated with adjusted antibiotics.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Microbiology

Background:

  • Steroid therapy can predispose patients to opportunistic infections.
  • Severe pneumonia with septic shock and acute respiratory distress syndrome (ARDS) requires prompt and accurate diagnosis.

Observation:

  • A 71-year-old female on steroids developed severe pneumonia unresponsive to broad-spectrum antibiotics targeting Pseudomonas aeruginosa.
  • Imaging revealed multiple round foci, initially raising concerns for malignancy or autoimmune disease.
  • Persistent high inflammatory markers and critical respiratory status indicated an atypical pathogen.

Findings:

  • Pulmonary nocardiosis caused by Nocardia farcinica was diagnosed due to the pathogen's long incubation period.
  • An environmental exposure, possibly contaminated "hay packs" from a health resort, was suspected as the source.
  • Adjusting the antibiotic regimen to target Nocardia species led to patient stabilization.

Implications:

  • This case highlights the importance of considering Nocardia infections in immunocompromised patients with severe pneumonia.
  • Prompt identification and appropriate antimicrobial therapy are crucial for favorable outcomes in pulmonary nocardiosis.
  • Environmental exposures should be investigated as potential sources of rare infectious agents.

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