Disseminated nocardiosis in a child with acute lymphoblastic leukemia

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2008-03, Vol.15 (3), p.275-278
• Main Authors: Bernoux, D, Mialou, V, Rodríguez-Nava, V, Boiron, P, Guibal, A-L, Moreux, N, Bertrand, Y, André, J-M
• Format: Article
• Language: fre
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Bronchoalveolar Lavage Fluid; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Nocardia Infections - complications; Nocardia Infections - diagnostic imaging; Nocardia Infections - pathology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnostic imaging; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Radiography
• ISSN: 0929-693X
• DOI: 10.1016/j.arcped.2007.12.006

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.