[A case of pulmonary nocardiosis associated with middle lobe atelectasis]

Pulmonary nocardiosis is a rare disease. We reported a case of pulmonary nocardiosis associated with middle lobe atelectasis. A 66-year-old female was admitted to Saga Medical School Hospital with complaints of fever, productive cough and hemosputum. Nocardia asteroides was isolated from her sputum and bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim (ST) improved her symptoms and Nocardia asteroides were rapidly eliminated from her sputum. However, she had severe side effects of ST: toxic dermatitis, granulocytopenia and liver dysfunction, whereupon administration of ST was stopped. About two weeks later, Nocardia asteroides appeared again in her sputum. Either netilmicin (NTL) or minocycline (MINO) given consecutively could not eliminate Nocardia asteroides from her sputa. Subsequently a combination therapy of OFLX administration and gentamicin inhalation was tried. This treatment improved her symptoms and eradicated Nocardia asteroides from her sputa completely. In vitro study, ST, MINO and aminoglycosides showed good susceptibility against Nocardia asteroides. In this case, it was revealed that GM inhalation therapy is also very useful for pulmonary Nocardiosis.