Case Report: Nocardia amamiensis Infection Leading to Worsening of Chronic Obstructive Pulmonary Disease Symptoms in an Elderly Man

Ahalya Kanakan Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Amit Kumar Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Upinder Kaur Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Prity Narwade Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Zinnu Rain Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Nidhi Yadav Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

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Ishan Kumar Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

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Deepak Kumar Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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Sankha Shubhra Chakrabarti Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India;

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ABSTRACT.

Nocardiosis is a rare opportunistic infection mostly affecting the lungs, brain, or skin of immunocompromised individuals. Most pulmonary nocardiosis patients present with nonspecific clinical features such as productive cough, exertional dyspnea, and fever. The disease is uncommonly suspected, especially in tuberculosis-endemic regions, and clinical diagnosis is often delayed, resulting in high mortality. Pulmonary nocardiosis in apparently immunocompetent individuals is uncommon. Here, we present the case of an elderly gentleman with a background history of poorly controlled diabetes but no history of systemic steroid use who presented with worsening symptoms of chronic obstructive pulmonary disease in the form of productive cough and dyspnea. The patient had diffuse crepitations in bilateral lung fields and an arterial oxygen saturation of 86% at admission. Sputum microscopy revealed gram-positive filamentous bacteria that could be successfully cultured and identified as Nocardia amamiensis on 16S ribosomal RNA sequencing. Contrast-enhanced computed tomography of the lungs revealed cavitary nodules and consolidation. The patient responded well to treatment with specific antibiotics based on sensitivity patterns. Because of the nonspecific clinical and radiological findings in pulmonary nocardiosis, a high index of suspicion is required, especially in tuberculosis-endemic regions.

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Author Notes

Disclosure: No human/animal experimentation was performed. Only standard medical/surgical care was provided and written informed consent was taken from the patient’s legal guardian to publish.

Authors’ addresses: Ahalya Kanakan, Amit Kumar, and Sankha Shubhra Chakrabarti, Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, E-mails: ahalya11235@gmail.com, amit87343@gmail.com, and sankha.geriatrics@gmail.com. Upinder Kaur, Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, E-mail: drupinder.bhu@gmail.com. Prity Narwade, Zinnu Rain, and Deepak Kumar, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, E-mails: pritynarwade7@gmail.com, zinnu1997@gmail.com, and deepak.mln30@gmail.com. Nidhi Yadav and Ishan Kumar, Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, E-mails: drnidhijpy11@gmail.com and ishan.imsrd@bhu.ac.in.

Address correspondence to Sankha Shubhra Chakrabarti, Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP 221005, India. E-mail: sankha.geriatrics@gmail.com
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