Intractable Rare Dis Res. 2014;3(1):25-28. (DOI: )

Pulmonary nocardiosis in patients with connective tissue disease: A report of two cases.

Hagiwara S, Tsuboi H, Hagiya C, Yokosawa M, Hirota T, Ebe H, Takahashi H, Ogishima H, Asashima H, Kondo Y, Umeda N, Suzuki T, Hitomi S, Matsumoto I, Sumida T

Reported here are 2 patients with connective tissue disease who developed pulmonary nocardiosis. Case 1 involved a 73-year-old man with malignant rheumatoid arthritis treated with prednisolone 25 mg/day. Chest X-rays revealed a pulmonary cavity and bronchoscopy detected Nocardia species. The patient was successfully treated with trimethoprim/sulfamethoxazole. Case 2 involved a 41-year-old woman with systemic lupus erythematosus. The patient received remission induction therapy with 50 mg/day of prednisolone and tacrolimus. Six weeks later, a chest CT scan revealed a pulmonary cavity; bronchoscopy resulted in a diagnosis of pulmonary nocardiosis. The patient had difficulty tolerating trimethoprim/sulfamethoxazole, so she was switched to and successfully treated with imipenem/cilastatin and amikacin.

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