Pulmonary nocardiosis and sarcoidosis

• Published in: Revue de pneumologie clinique Vol. 69; no. 3; pp. 139 - 143
• Main Authors: Rkiouak, A, Zinebi, A, Rabhi, M, Reggad, A, Akhouad, Y, Ennibi, K, Boudlal, M, Chaari, J
• Format: Journal Article
• Language: French
• Published: France 01.06.2013
• Subjects: Adult; Anti-Infective Agents - therapeutic use; Female; Humans; Nocardia Infections - complications; Nocardia Infections - diagnostic imaging; Nocardia Infections - drug therapy; Radiography, Thoracic; Sarcoidosis, Pulmonary - complications; Sarcoidosis, Pulmonary - diagnostic imaging; Sarcoidosis, Pulmonary - drug therapy; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 0761-8417
• DOI: 10.1016/j.pneumo.2012.12.001

Infectious complications are rarely observed in the course of sarcoidosis. Only small series or cases reports of infection are described in sarcoidosis. Corticosteroids-induced immune suppression, pulmonary fibrosis and T-CD4 lymphopenia, are often present. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. We report a case of pulmonary nocardiosis in a patient with sarcoidosis followed for pulmonary fibrosis receiving corticosteroids. During the investigation of pyrexia and dyspnea, evidence of Nocardia spp. infection was found in the bronchial secretions. Six months of trimethoprim/sulfamethoxazole therapy ensured further resolution of this pleuropulmonary infection. Pulmonary nocardiosis is exceptional in sarcoidosis and mainly occur, in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.