Pulmonary Nocardia infection in a child with idiopathic pulmonary hemosiderosis

• Published in: BMC pulmonary medicine Vol. 21; no. 1; p. 182
• Main Authors: Qin, Lu, Zhang, Fei-Zhou, Yang, Tong-Yu, Tao, Xiao-Fen, Tang, Lan-Fang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.05.2021; BioMed Central; BMC
• Subjects: Actinomycetales infections; Adrenal Cortex Hormones - therapeutic use; Alveoli; Anemia; Bacteria; Blood; Bronchoalveolar Lavage Fluid - microbiology; Bronchus; Case Report; Case studies; Child; Complications and side effects; Corticosteroid; Corticosteroids; Cough; Diagnosis, Differential; Disease; DNA sequencing; Dosage; Drug therapy; Dyspnea; Female; Fungal infections; Gastric juice; Hemoglobin; Hemoptysis; Hemorrhage; Hemosiderin-laden macrophages; Hemosiderosis; Hemosiderosis - complications; Hemosiderosis - diagnosis; Hemosiderosis - drug therapy; Hemosiderosis, Pulmonary; High-Throughput Nucleotide Sequencing; Humans; Idiopathic; Immunocompromised Host; Immunocompromised hosts; Immunodeficiency; Lavage; Linezolid; Lung Diseases - complications; Lung Diseases - diagnosis; Lung Diseases - drug therapy; Lungs; Macrophages; Macrophages - pathology; Next-generation sequencing; Nocardia; Nocardia - genetics; Nocardia Infections - complications; Nocardia Infections - diagnosis; Nocardia Infections - etiology; Pain; Pathogens; Patients; Pediatric research; Pediatrics; Pleura; Pneumonia; Pulmonary hemosiderosis; Pulmonary lesions; Pulmonology; Sputum; Sulfonamides; China; Corticosteroid; Nocardia; Hemosiderin-laden macrophages; Pulmonary hemosiderosis; Idiopathic
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-021-01544-0

Idiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH; however, it can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection after the corticosteroid treatment of IPH. A 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice, which supported the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Next-generation sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in follow-up. Nocardia infection should be considered in the differential diagnoses for IPH patients receiving corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Next-generation sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or linezolid are effective for pediatric pulmonary Nocardia infection.