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Case Reports
. 2021 Sep;35(9):e23902.
doi: 10.1002/jcla.23902. Epub 2021 Aug 21.

A rare case of pulmonary nocardiosis comorbid with Sjogren's syndrome

Yumeng Peng  1   2 , Xiaoyan Dong  3 , Yongze Zhu  1 , Huoyang Lv  1 , Yumei Ge  1
Affiliations
Case Reports

A rare case of pulmonary nocardiosis comorbid with Sjogren's syndrome

Yumeng Peng et al. J Clin Lab Anal. 2021 Sep.

Abstract

Background: Nocardia is an opportunistic pathogen, which occurs in patients with autoimmune diseases and immune dysfunction, and can cause bacteremia and other life-threatening complications. The clinical manifestations of Nocardia pneumonia are similar to tuberculous and other clinical common bacterial pneumonia, but its antibacterial treatments are different and detection methods are unique, which may lead patients to suffer for many years due to clinical misdiagnosis and missed diagnosis.

Methods: Imaging and laboratory examinations were performed for preliminary diagnosis, and next-generation sequencing was used to identify the exact species type of Nocardia in the bronchoalveolar lavage fluid (BALF) of the patient.

Results: Imaging and laboratory parameters preliminarily implied that the patient was infected with Nocardia with Sjogren's syndrome (SS), and NGS showed that the strain was N. terpenica.

Conclusions: Accurate etiological diagnosis and corresponding antibiotics are key to improve the prognosis of pulmonary nocardiosis in this case. Nocardia pneumonia is rare in clinical practice; it is of great medical significance to improve the understanding of pulmonary nocardiosis.

Keywords: Nocardia terpenica; Sjogren's syndrome; etiological examination; next-generation sequencing; pneumonia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

FIGURE 1
FIGURE 1
High‐resolution computed tomography (HRCT) of the thorax showed bronchiectasis and inflammation involving in both lungs. Patchy and nodular high‐density shadows were scattered in both lungs, with unclear margin. Bilateral bronchiectasis and wall thickening were observed. Nodular high‐density shadows were found in local lumen, especially in right lung. The right upper lobe (Se4, im69) showed nodular high‐density shadow with unclear edge, about 9 mm in diameter. Small nodules and dense foci were seen in the right lung. In addition, small cystic areas without lung markings were found in both lungs, with clear edges
FIGURE 2
FIGURE 2
The results of cellular report of alveolar lavage fluid. There were many nucleated cells, mainly neutrophils, macrophages, lymphocytes, eosinophils, hemosiderin granules, radial rod‐shaped bacteria, and no fungi or other special abnormal cells were found in alveolar lavage
FIGURE 3
FIGURE 3
(A) Gram‐positive and slender branching rods initially considered as Nocardia. Sputum specimen was Gram‐stained and examined under an oil immersion microscope at ×1000 magnification. (B) Acid‐fast branching rods on Ziehl‐Neelsen stain of sputum smear examined under an oil immersion microscope at ×1000 magnification. Weakly acid‐fast, filamentous bacteria with branched vegetative hyphae could be clearly observed in the blue background
See this image and copyright information in PMC

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