Respir Case Rep. 2023; 12(2): 46-49 | DOI: 10.5505/respircase.2023.57983

Pulmonary Nocardiosis Mimicking Pulmonary Tuberculosis in an Immunocompetent Patient Diagnosed by Cytology of Bronchoscopic Lavage

Hülya Abalý¹, Efsun Gonca Uður Chousein¹, Derya Hýrçýn Cenger², Neslihan Fener^3
1Department of Chest Diseases, Yedikule Chest Diseases and Tho-racic Surgery Training and Research Hospital, Ýstanbul, Türkiye
²Department of Infectious Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Ýstanbul, Türkiye
³Department of Pathology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Ýstanbul, Türkiye

Nocardia infections are common in immunocompromised and organ transplant patients, although Nocardia species only rarely cause infections in immunocompetent patients. Pulmonary nocardiosis is the most common clinical manifestation of Nocardia species, and may imitate several pulmonary diseases, such as pulmonary tuberculosis (TB) in such high-risk settings for TB as Türkiye. We present here a rare case of an immunocompetent patient with pulmonary nocardiosis mimicking tuberculosis in terms of the history, clinical symptoms and radiological findings. Acid-fast staining and real-time polymerase chain reaction testing of the bronchoscopic lavage were negative for TB, and no Mycobacterium species proliferated in the culture. Two similar diseases were differentiated by lavage cytology. The patient improved dramatically following a short course of treatment over two months.

Keywords: Pulmonary nocardiosis, tuberculosis, im-munocompetent, lavage cytology

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Bronkoskopik Lavaj Sitolojisiyle Teþhis Edilen Ýmmünokompetan Bir Hastada Pulmoner Tüberkülozu Taklid Eden Pulmoner Nokardiozis

Hülya Abalý¹, Efsun Gonca Uður Chousein¹, Derya Hýrçýn Cenger², Neslihan Fener^3
1Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Göðüs Hastalýklarý Anabilim Dalý, Ýstanbul
²Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Enfeksiyon Hastalýklarý Anabilim Dalý, Ýstanbul
³Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Patoloji Anabilim Dalý, Ýstanbul

Nokardiya enfeksiyonlarý, baðýþýklýðý baskýlanmýþ ve organ nakli olan hastalarda sýk görülür, ayrýca, Nokardiya türleri immünokompetan hastalarda nadiren enfeksiyona neden olur. Pulmoner nokardiozis, Nokardiya türlerinin en sýk görülen klinik manifestasyonudur ve Türkiye gibi pulmoner tüberküloz (TB) için yüksek riskli bölgelerde sýklýkla pulmoner tüberküloz gibi birçok pulmoner hastalýðý taklid edebilir. Anamnez, klinik semptomlar ve radyolojik bulgulara göre pulmoner tüberkülozu taklit eden pulmoner nokardiozis tanýsý alan nadir bir immünokompetan olguyu sunuyoruz. Bronkoskopik lavajýn aside dirençli boyamasý ve real-time polimeraz zincir reaksiyonu TB için negatifti ve kültürde hiçbir Mikobakteri türü üremedi. Ýki benzer hastalýðýn ayýrýcý tanýsý lavaj sitolojisi ile yapýldý. Ýki aylýk kýsa süreli bir tedavi ile dramatik bir iyileþme gözlendi.

Anahtar Kelimeler: Pulmoner nokardiozis, tüberküloz, immünokompetan, lavaj sitolojisi

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