0
Chest Infections |

An Infectious Case of a Solitary Pulmonary Nodule

Timothy Hauser, MD; Joel Nations, MD
Author and Funding Information

Walter Reed National Military Medical Center, Bethesda, MD


Chest. 2014;146(4_MeetingAbstracts):134A. doi:10.1378/chest.1992334
Text Size: A A A
Published online

Abstract

SESSION TITLE: Infectious Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: The etiology of pulmonary nodules can vary widely including malignancy, infection or inflammation. History and risk factors can sometimes lead the workup in the wrong direction. We present a case of an 82 year old male with a left upper lobe nodule.

CASE PRESENTATION: An 82 year old male is evaluated for a pulmonary nodule noted on pre-operative chest x-ray. The patient had developed amiodarone induced thyrotoxicosis and failed corticosteroid therapy prompting the need for thyroidectomy. A CT scan revealed a solitary 2.5 x 2.2cm nodule. His history is significant for 6 months of steroid use, a 30 pack year history and COPD. A PET scan confirmed avidity of the nodule, in addition to a 1 x 1 cm left deltoid avid lesion. Ultrasound guided FNA of the deltoid lesion revealed neutrophils but no malignant cells or organisms. Bronchoscopy of the LUL nodule was nondiagnostic. CT guided biopsy of the pulmonary nodule and a core biopsy of the deltoid lesion both showed no malignant cells but had weakly acid fast positive filamentous bacteria consistent with nocardia. Cultures revealed nocardia cyriacigeorgica. The patient was treated with oral trimethoprim sulfamethoxazole (TMP-SMX) and intravenous ceftriaxone.

DISCUSSION: Nocardiosis is a risk in immunosuppression including corticosteroids alone. One case series showed that nearly 2% of lung transplant recipients developed nocardia infection. 39% of patients with nocardia infection present with pulmonary disease alone, while disseminated nocardiosis can occurs in up to 32%. Pulmonary manifestations of nocardia include pulmonary nodules, interstitial infiltrates, reticulonodular pattern, and pleural plaques. TMP-SMX has variable efficacy as a prophylactic agent depending on the dose and frequency with daily dosing being shown to be more effective than three times weekly dosing.

CONCLUSIONS: Opportunistic infections are a growing concern in the medical community with the increase in immunosuppressive therapies. Currently there are no guidelines regarding prophylactic therapy for most immunosuppressed patients.

Reference #1: Wilson, John W. Nocardiosis: Updates and Clinical Overview. Mayo Clinic Proceedings. 2012; April:87(4):403-407

Reference #2: Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev. 1994:7(2):213

Reference #3: Poonyagariyagorn HK et al. Challenges in the diagnosis and management of Nocardia infections in lung transplant recipients. Transpl Infect Dis 2008; 10(6): 403-8

DISCLOSURE: The following authors have nothing to disclose: Timothy Hauser, Joel Nations

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543