Nocardia lung abscess in an immunocompetent adolescent

• Published in: BMJ case reports 2019-01, Vol.12 (1), p.bcr-2018-227499
• Main Authors: Soares, Diana, Reis-Melo, Ana, Ferraz, Catarina, Guedes Vaz, Luisa
• Format: Article
• Language: English
• Subjects: Abscesses; Administration, Intravenous; Adolescent; Aftercare; Alcohol; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Antibiotics; Antigens; Case reports; Chronic obstructive pulmonary disease; Diagnosis, Differential; Disease; Dyspnea; Emergency medical care; Fever; Gram-positive bacteria; Humans; Immunocompetence; Laboratories; Lung Abscess - diagnostic imaging; Lung Abscess - drug therapy; Lung Abscess - microbiology; Male; Medical imaging; Neutrophils; Nocardia - genetics; Nocardia - isolation & purification; Nocardia Infections - diagnostic imaging; Nocardia Infections - drug therapy; Nocardia Infections - microbiology; Pain; Pediatrics; Reminder of Important Clinical Lesson; Streptococcus infections; Substance abuse treatment; Teenagers; Tomography, X-Ray Computed; Tonsillitis - drug therapy; Treatment Outcome; Tuberculosis; Ultrasonic imaging; Vaccines
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-227499

The authors report a case of a lung abscess caused by Nocardia sp. in a previously healthy adolescent. A 17-year-old young man presented with tonsillitis that did not respond to β-lactamic antibiotic, dyspnoea and thoracic pain. The X-ray revealed a cavitation in the right pulmonary upper lobe. He was admitted and completed a 14-day empirical antimicrobial therapy for a pulmonar abscess, although no clinical recovery was observed. He then underwent pulmonary biopsy of the lesion and PCR analysis of the collected pulmonary tissue, which revealed the presence of Nocardia. This case emphasises the importance of considering nocardiosis in the differential diagnosis of a lung abscess, particularly if no response to empirical therapy is obtained.