Necrotizing Nocardial Pneumonitis

Publisher Website
Google Scholar
Abstract
These cases of acute necrotizing nocardial pneumonitis have been presented to again illustrate the problems that can be associated with nocardiosis, for this is a treatable infection if recognized early. The 4 patients all had an underlying chronic illness thought to be associated with abnormalities of immune mechanisms and were on steroid therapy. In each case the onset of the illness was acute and the diagnosis was achieved only after extensive bacteriological study. In 2 of the patients diagnosis was made only after death, even though the infection was widespread and considered earlier. Case 1 illustrates what appears to be the 1st female case of heavy chain disease in which the nocardiosis was truly fulminant. Nocardia asteroides must be differentiated from Mycobacterium fortuitum. The organism can be identified in pathological material only with methanamine silver stains. Although it is unclear whether N. asteroides is at times a simple saprophyte isolation of the organism in a case of active pulmonary disease has always been associated with active disease. Sulfonamides remain the therapy of choice even though one case survived when treated with chloramphenicol. Therapy should probably be continued for up to a year to fully eradicate the organism.
Keywords