Tariq Butt, Rifat Nadeem Ahmad, Mohammad Farooque, Abid Mahmood, Pervaiz Ahmed.
Pulmonary Nocardiosis in an immunocompromised host
Pak Armed Forces Med J Jun 2003;53(1):96-8.
Armed Forces Institute of Pathology, Rawalpindi

A 25 years old man suffering from chronic myeloid leukemia in lymphoblastic transformation was admitted to the Armed Forces Bone Marrow Transplantation Centre, Rawalpindi in February 2002. On admission, he had generalized aches and fever for the past fifteen days. On examination, he was anaemic with temperature of 100°F. His spleen was 4 cm enlarged and liver edge was palpable. The rest of the general and systemic examination was unremarkable. Bone marrow examination confirmed the diagnosis of acute lymphoblastic leukaemia, most likely transformed from chronic myeloid leukaemia. He was put on chemotherapy. After the second course of chemotherapy, he went into remission. While he was waiting for cranial irradiation, he developed low-grade fever. On examination, he had a temperature of 100°F. Rest of his general and systemic examination was unremarkable with normal Labs. He was empirically put on ceftazidime 2g intravenously 12 hourly and amikacin 500mg - intravenously 12 hourly. This treatment was continued for 7 days, but his fever did not respond. Meanwhile he developed harsh vesicular breathing and repeat x-ray chest revealed ill defined patchy opacities in his left lung field. At this time all the investigations done previously, were repeated and he was put on amphotericin B infusion daily and piperacillin-tazobactam 4.5g intravenously 8 hourly. Amikacin was continued whereas ceftazidime was omitted. All repeated labor investigations revealed no abnormality. He was also put on ATT. When after 10 days no response was noted, bronchioalveolar lavage (BAL) was planned and bacterial culture of 96 hours revealed growth of Nocardia asteroids while other investigations were negative.

Category: Case Reports
Keywords: Nocardiosis. Immunocompromise.

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