Abstract
We describe a rare case of recurrent pulmonary nocardiosis (PN) in a hematopoietic stem cell transplant recipient. The patient developedNocardia farcinica infection while receiving corticosteroid and cyclosporine for the treatment of bronchiolitis obliterans, probably due to chronic graft-versus-host disease (cGVHD).The patient responded well to the initial treatment with meropenem, but PN recurred 3 times during oral maintenance therapies using different antibiotics, which were chosen on the basis of the results of in vitro susceptibility testing againstN farcinica. Minocycline, amoxicillin/clavulanate, and levofloxacin were not effective as oral maintenance therapies. Frequent exacerbation of PN was considered to have resulted from the low blood concentration of these antibiotics, and decreased gastrointestinal absorption, probably due to cGVHD, might have been the underlying problem.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Quabeck K. The lung as a critical organ in marrow transplantation.Bone Marrow Transplant. 1994;14(Suppl 4):S19-S28.
Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation.Chest. 1996;109:1066–1077.
King CT, Chapman SW, Butkus DE. Recurrent nocardiosis in a renal transplant recipient.South Med J. 1993;86:225–228.
Chapman SW, Wilson JP. Nocardiosis in transplant recipients.Semin Respir Infect. 1990;5:74–79.
Shearer C, Chandrasekar PH. Pulmonary nocardiosis in a patient with a bone marrow transplant: Bone Marrow Transplantation Team.Bone Marrow Transplant. 1995;15:479–481.
Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of theNocardia spp. based on current molecular taxonomy.Clin Microbiol Rev. 2006;19:259–282.
Chouciño C, Goodman SA, Greer JP, Stein RS, Wolff SN, Dummer JS. Nocardial infections in bone marrow transplant recipients.Clin Infect Dis. 1996;23:1012–1019.
vanBurik JA, Hackman RC, Nadeem SQ, et al. Nocardiosis after bone marrow transplantation: a retrospective study.Clin Infect Dis. 1997;24:1154–1160.
Torres HA, Reddy BT, Raad II, et al. Nocardiosis in cancer patients.Medicine (Baltimore). 2002;81:388–397.
Wiesmayr S, Stelzmueller I, Tabarelli W, et al. Nocardiosis following solid organ transplantation: a single-centre experience.Transpl Int. 2005;18:1048–1053.
Smego RA Jr, Moeller MB, Gallis HA. Trimethoprim-sulfamethoxazole therapy forNocardia infections.Arch Intern Med. 1983;143:711–718.
Lo W, Rolston KV. Use of imipenem in the treatment of pulmonary nocardiosis.Chest. 1993;103:951–952.
Mari B, Montón C, Mariscal D, Luján M, Sala M, Domingo C. Pulmonary nocardiosis: clinical experience in ten cases.Respiration. 2001;68:382–388.
Tanvetyanon T, Toor AA, Stiff PJ.Post-transplant air-leak syndrome.Br J Haematol. 2004;126:758.
Author information
Authors and Affiliations
Corresponding author
Additional information
K.K. is on leave from the Hematology Division, Tokyo Medical and Dental University, Tokyo, Japan.
About this article
Cite this article
Kakihana, K., Ohashi, K., Iguchi, M. et al. Frequent exacerbation of pulmonary nocardiosis during maintenance antibiotic therapies in a hematopoietic stem cell transplant recipient. Int J Hematol 86, 455–458 (2007). https://doi.org/10.1007/BF02984005
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02984005