array:23 [
  "pii" => "S1579212921004055"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2020.05.019"
  "estado" => "S300"
  "fechaPublicacion" => "2021-12-01"
  "aid" => "2518"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2021;57:768"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1579212921004043"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2020.05.018"
    "estado" => "S300"
    "fechaPublicacion" => "2021-12-01"
    "aid" => "2520"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2021;57:769"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
      "titulo" => "Is it Cyst or Neoplasm&#63; The Role of Thorax Magnetic Resonance Imaging"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "769"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Quiste o neoplasia&#63; El papel de la resonancia magn&#233;tica de t&#243;rax"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1252
              "Ancho" => 1267
              "Tamanyo" => 167582
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Chest X ray PA view showing an ill-defined radiopacity in left upper lung field&#46; &#40;b&#41; T2 weighted imagines haste coronal view hyperintense lesion was observed&#46; There was band formation compatible with germinative membrane in the lesion&#46; &#40;c&#41; Positron emission tomography &#40;PET&#41;&#47;computed tomography &#40;CT&#41; showed hypometabolic cavitary lesion was observed in the left lung upper lobe&#46; &#40;d&#41; T2 weighted imagines haste axial view hyperintense lesion was observed&#46; There was band formation compatible with germinative membrane in the lesion&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Adem Karaman, Elif Yilmazel Ucar, Serhat Kaya, &#214;mer Araz"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Adem"
              "apellidos" => "Karaman"
            ]
            1 => array:2 [
              "nombre" => "Elif Yilmazel"
              "apellidos" => "Ucar"
            ]
            2 => array:2 [
              "nombre" => "Serhat"
              "apellidos" => "Kaya"
            ]
            3 => array:2 [
              "nombre" => "&#214;mer"
              "apellidos" => "Araz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921004043?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921004043/v3_202201080532/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1579212921004067"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2020.05.020"
    "estado" => "S300"
    "fechaPublicacion" => "2021-12-01"
    "aid" => "2515"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2021;57:767"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
      "titulo" => "Bronchial and Tracheal Mucosa-Associated Lymphoid Tissue Lymphoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "767"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Linfoma del tejido linfoide asociado a mucosas bronquial y traqueal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 600
              "Ancho" => 761
              "Tamanyo" => 116145
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal &#40;A&#41; and sagittal &#40;B&#41; reformatted images and a three-dimensional external rendering &#40;C&#41; of a chest computed tomography image show nodular lesions in the trachea and left main bronchus&#44; with irregular luminal narrowing and severe stenosis&#46; &#40;D&#41; <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose positron emission tomography&#47;computed tomography demonstrated increased fluorodeoxyglucose uptake in the left main bronchus&#44; with a maximum standard uptake value of 8&#46;4&#46; &#40;E&#41; Fiberoptic bronchoscopy revealed multiple small nodular mucosal lesions with a cobblestone appearance along the trachea and left main bronchus&#46; &#40;F&#41; A histopathological section demonstrating the proliferation of atypical small lymphoid cells&#44; compatible with lymphoma &#40;hematoxylin and eosin stain&#44; 100&#215; magnification&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luciana Volpon Soares Souza, Arthur Soares Souza, Edson Marchiori"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Luciana Volpon Soares"
              "apellidos" => "Souza"
            ]
            1 => array:3 [
              "nombre" => "Arthur Soares"
              "apellidos" => "Souza"
              "sufijo" => "Jr"
            ]
            2 => array:2 [
              "nombre" => "Edson"
              "apellidos" => "Marchiori"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921004067?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921004067/v3_202201080532/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
    "titulo" => "Cavitary Lesions in a Hematopoietic Stem Cell Transplant Patient"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "768"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Badar Patel, Ajay Sheshadri, Saadia A&#46; Faiz"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Badar"
            "apellidos" => "Patel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ajay"
            "apellidos" => "Sheshadri"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Saadia A&#46;"
            "apellidos" => "Faiz"
            "email" => array:1 [
              0 => "safaiz@mdanderson.org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "McGovern Medical School at UTHealth&#44; Houston&#44; TX&#44; United States"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Pulmonary Medicine&#44; The University of Texas MD Anderson Cancer Center&#44; Houston&#44; TX&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Lesiones cavitadas en un paciente receptor de un trasplante de c&#233;lulas madre hematopoy&#233;ticas"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 684
            "Ancho" => 900
            "Tamanyo" => 197558
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Computed tomography of chest reveals new cavitary nodules in the right lower lung&#46; The right lower lung cavitary lesion &#40;yellow arrow&#41; is adjacent to a bronchus &#40;yellow carrot&#41;&#46; &#40;B&#41; Convex-probe endobronchial ultrasound image of thickened cavitary wall &#40;yellow asterisk&#41; of right lower lobe opacity&#46; &#40;C&#41; Gomori Methenamine-Silver nitrate statin &#40;A&#44; 600&#215;&#41; highlights the branching gram-positive filamentous organisms&#46; &#40;D&#41; <span class="elsevierStyleItalic">Nocardia</span> is weakly acid-fast&#44; and FITE &#40;B&#44; 600&#215;&#41; stain&#44; which is a modified acid fast stain&#44; is positive with the branching filamentous organism&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A middle-aged man with chronic lymphocytic leukemia status post hematopoietic stem cell transplantation &#40;day 210&#41; was admitted with diarrhea&#46; His clinical course was complicated with skin and gastrointestinal &#40;grade IV&#41; graft-versus-host disease&#46; He was maintained on antimicrobial &#40;valacyclovir&#44; levofloxacin&#44; atovaquone&#44; isavuconazonium&#41; and immunosuppressive therapy &#40;tacrolimus&#44; methylprednisolone&#44; sirolimus&#44; ruxolitinib&#44; vedolizumab&#44; extracorporeal photopheresis&#41;&#46; He developed a dry cough&#44; and a computed tomograpy &#40;CT&#41; scan of the chest revealed 2 cavitary opacities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Cavitary lesions were thick walled and located in the right lower lobe and left upper lobe without associated parenchymal lesions&#46; Given its proximity to the airway&#44; in addition to a bronchoalveolar lavage &#40;BAL&#41;&#44; convex-probe-endobronchial ultrasound &#40;c-EBUS&#41; guided transbronchial needle aspiration &#40;TBNA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; was performed&#46; Cytology revealed gram-positive filamentous branching rods later on identified as <span class="elsevierStyleItalic">Nocardia kruczakiae</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C &#38; D&#41;&#46; Additional anti-bacterial therapy was initiated&#46; Unfortunately&#44; clinical course was complicated by gastrointestinal bleeding&#44; and he passed away 2 months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Nocardia</span> is an opportunistic gram-positive organism notorious for its ability to invade any organ&#44; and lungs and the central nervous system are frequently affected&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Inhalation is the typical route of infection&#44; but inoculation and transmission from the gastrointestinal tract are also reported&#46; Pulmonary nocardiosis occurs most frequently in immunocompromised patients&#44; and risk factors include diabetes&#44; organ transplantation&#44; use of steroids and calcineurin inhibitor&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Radiographic presentation may vary and includes consolidation&#44; nodules&#44; cavities and masses&#44; and these are typically mistaken for fungal infection or malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> In our case&#44; BAL and EBUS-TBNA confirmed <span class="elsevierStyleItalic">Nocardia</span>&#44; and cytology facilitated prompt diagnosis&#46; In those with acceptable hematologic parameters and accessible lesions&#44; EBUS-TBNA may be a helpful adjunct to BAL as a diagnostic tool&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">BP&#44; AS&#44; SAF&#58; conception and design&#44; acquisition of radiological and pathological data&#44; drafting the article&#44; critical revision of intellectual content and final approval of the version to be published</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research is supported in part by the National Institutes of Health through <span class="elsevierStyleGrantSponsor" id="gs1">MD Anderson&#39;s Cancer Center Support Grant</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">CA016672</span>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no conflicts of interest exist</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Author contributions"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Funding"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 684
            "Ancho" => 900
            "Tamanyo" => 197558
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Computed tomography of chest reveals new cavitary nodules in the right lower lung&#46; The right lower lung cavitary lesion &#40;yellow arrow&#41; is adjacent to a bronchus &#40;yellow carrot&#41;&#46; &#40;B&#41; Convex-probe endobronchial ultrasound image of thickened cavitary wall &#40;yellow asterisk&#41; of right lower lobe opacity&#46; &#40;C&#41; Gomori Methenamine-Silver nitrate statin &#40;A&#44; 600&#215;&#41; highlights the branching gram-positive filamentous organisms&#46; &#40;D&#41; <span class="elsevierStyleItalic">Nocardia</span> is weakly acid-fast&#44; and FITE &#40;B&#44; 600&#215;&#41; stain&#44; which is a modified acid fast stain&#44; is positive with the branching filamentous organism&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:2 [
            0 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary nocardiosis&#58; computed tomography features at diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46;N&#46; Blackmon"
                            1 => "J&#46;G&#46; Ravenel"
                            2 => "J&#46;M&#46; Gomez"
                            3 => "J&#46; Ciolino"
                            4 => "D&#46;W&#46; Wray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RTI.0b013e3181f45dd5"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "224"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21785288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nocardia infections in solid organ and hematopoietic stem cell transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Coussement"
                            1 => "D&#46; Lebeaux"
                            2 => "C&#46; Rouzaud"
                            3 => "O&#46; Lortholary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QCO.0000000000000404"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Infect Dis"
                        "fecha" => "2017"
                        "volumen" => "30"
                        "paginaInicial" => "545"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28922286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005700000012/v3_202201080532/S1579212921004055/v3_202201080532/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "60604"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Clinical Images"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005700000012/v3_202201080532/S1579212921004055/v3_202201080532/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921004055?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 57. Issue 12.
Pages 768 (December 2021)
Share
Share
Download PDF
More article options
Visits
1819
Vol. 57. Issue 12.
Pages 768 (December 2021)
Clinical Image
Full text access
Cavitary Lesions in a Hematopoietic Stem Cell Transplant Patient
Lesiones cavitadas en un paciente receptor de un trasplante de células madre hematopoyéticas
Visits
1819
Badar Patela, Ajay Sheshadrib, Saadia A. Faizb,
Corresponding author
safaiz@mdanderson.org

Corresponding author.
a McGovern Medical School at UTHealth, Houston, TX, United States
b Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

A middle-aged man with chronic lymphocytic leukemia status post hematopoietic stem cell transplantation (day 210) was admitted with diarrhea. His clinical course was complicated with skin and gastrointestinal (grade IV) graft-versus-host disease. He was maintained on antimicrobial (valacyclovir, levofloxacin, atovaquone, isavuconazonium) and immunosuppressive therapy (tacrolimus, methylprednisolone, sirolimus, ruxolitinib, vedolizumab, extracorporeal photopheresis). He developed a dry cough, and a computed tomograpy (CT) scan of the chest revealed 2 cavitary opacities (Fig. 1A). Cavitary lesions were thick walled and located in the right lower lobe and left upper lobe without associated parenchymal lesions. Given its proximity to the airway, in addition to a bronchoalveolar lavage (BAL), convex-probe-endobronchial ultrasound (c-EBUS) guided transbronchial needle aspiration (TBNA) (Fig. 1B) was performed. Cytology revealed gram-positive filamentous branching rods later on identified as Nocardia kruczakiae (Fig. 1C & D). Additional anti-bacterial therapy was initiated. Unfortunately, clinical course was complicated by gastrointestinal bleeding, and he passed away 2 months later.

Fig. 1.

(A) Computed tomography of chest reveals new cavitary nodules in the right lower lung. The right lower lung cavitary lesion (yellow arrow) is adjacent to a bronchus (yellow carrot). (B) Convex-probe endobronchial ultrasound image of thickened cavitary wall (yellow asterisk) of right lower lobe opacity. (C) Gomori Methenamine-Silver nitrate statin (A, 600×) highlights the branching gram-positive filamentous organisms. (D) Nocardia is weakly acid-fast, and FITE (B, 600×) stain, which is a modified acid fast stain, is positive with the branching filamentous organism.

(0.19MB).

Nocardia is an opportunistic gram-positive organism notorious for its ability to invade any organ, and lungs and the central nervous system are frequently affected.1 Inhalation is the typical route of infection, but inoculation and transmission from the gastrointestinal tract are also reported. Pulmonary nocardiosis occurs most frequently in immunocompromised patients, and risk factors include diabetes, organ transplantation, use of steroids and calcineurin inhibitor.2 Radiographic presentation may vary and includes consolidation, nodules, cavities and masses, and these are typically mistaken for fungal infection or malignancy.1 In our case, BAL and EBUS-TBNA confirmed Nocardia, and cytology facilitated prompt diagnosis. In those with acceptable hematologic parameters and accessible lesions, EBUS-TBNA may be a helpful adjunct to BAL as a diagnostic tool.

Author contributions

BP, AS, SAF: conception and design, acquisition of radiological and pathological data, drafting the article, critical revision of intellectual content and final approval of the version to be published

Funding

This research is supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support Grant (CA016672).

Conflicts of interest

The authors declare that no conflicts of interest exist

References
[1]
K.N. Blackmon, J.G. Ravenel, J.M. Gomez, J. Ciolino, D.W. Wray.
Pulmonary nocardiosis: computed tomography features at diagnosis.
J Thorac Imaging, 26 (2011), pp. 224-229
[2]
J. Coussement, D. Lebeaux, C. Rouzaud, O. Lortholary.
Nocardia infections in solid organ and hematopoietic stem cell transplant recipients.
Curr Opin Infect Dis, 30 (2017), pp. 545-551
Copyright © 2020. SEPAR
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?