SESSION TITLE: Interstitial Lung Disease Case Report Posters I
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Organizing pneumonia (OP) has been described in the setting of prior infections. We describe a case where Nocardia Nova is causative of the clinical and pathological features of OP.
CASE PRESENTATION: A 70 years old male is referred with complaints of cough, chest pain and intermittent fever. The patient had a history of myelodysplastic syndrome and underwent an unrelated cord blood cell transplant 5 months prior to presentation. The patient had previously received prednisone and mycophenolate mofetil as well as tacrolimus. Chest radiographs showed an evolving right upper lobe infiltrate confirmed by a computed tomography (CT) of the chest. There were crackles in the right hemithorax and no other relevant physical findings. Laboratory results, including white blood cell count, were normal. A bronchoscopy was performed with bronchoalveloar lavage and transbronchial biopsies. The lung parenchyma showed acute inflammation and exudates superimposed on young fibrogenic foci compatible with OP. Gomori-Grocott methenamine silver stain (GMS) stain showed rare filamentous organisms. The cultures were positive for nocardia nova. The patient received antibiotic treatment and no corticosteroids. After 3 months, he has demonstrated remarkable clinical and radiographic improvement.
DISCUSSION: Organizing pneumonia may present with a variety of clinical and radiographic manifestations and distinct histopathologic findings. Symptoms include cough, dyspnea, fever, chest pain, malaise and crackles. Chest radiography and CT scans most commonly reveal bilateral or unilateral consolidations. Pathology shows intraluminal plugs of organizing connective tissue within distal airways, as well as in alveolar ducts and peribronchiolar alveolar spaces. Organizing pneumonia may be caused by exposure to certain drugs; it may also be secondary to connective tissue diseases, solid tumors, infections, organ transplantation, inhalational injury and radiation injury among other cited sources. Treatment frequently involves corticosteroids in addition to eliminating the offending agent if known. Amongst the infectious etiologies of OP, there are few reports of nocardiosis.
CONCLUSIONS: We present a case of OP with nocardiosis that improved with antibiotic treatment alone. The patient was likely infected with Nocardia nova post stem cell transplant while on immunosuppression, and this resulted in the development of secondary OP. Our case strengthens the evidence supporting the association of nocardia infection and organizing pneumonia.
Reference #1: Nishida et al. Pulmonary nocardiosis developed in a hematopoietic stem cell transplant recipient with bronchiolitis obliterans. Int. Med 2010; 49: 1441-1444
Reference #2: F. Drakopanagiotakis et al. Cryptogenic and secondary organizing pneumonia. Clinical presentation, radiographic findings, treatment response, and prognosis Chest. 2011; 139: 893-900
DISCLOSURE: The following authors have nothing to disclose: Sumera Ahmad, Andres Sosa
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