Pulmonary Nocardiosis with Brain Abscess: A Case Report and Literature Review

肺部奴卡氏菌感染症併發腦膿瘍：病例報告和文獻回顧

柯延昆(Yen-Kun Ko) ； 徐志育(Chih-Yu Hsu)

《胸腔醫學》 18卷6期 (2003/12) Pp. 507-512

https://doi.org/10.29806/TM.200312.0005

摘要

奴卡氏菌感染在臨床上是較為少見的疾病，一般被認為是一種伺機性感染，通常發生在免疫功能異常的人身上。我們報告一位長期使用類固醇藥物的慢性阻塞性肺病發生急性惡化的患者。在住院7天後，開始發高燒並產生了兩側性肺炎。病患不幸在住院期間接著發生急性呼吸衰竭及多發性腦膿瘍。深部痰液的革蘭氏染色發現了典型的奴卡氏菌，於是開始使用trimethoprim-sulfamethoxazole及minocycline來治療肺部奴卡氏菌感染症，甚至加上ceftriaxone來治療腦膿瘍。在合適的抗生素治療下，肺炎逐漸的改善，但是中樞神經症狀卻仍然持續惡化。在住院第38天時，病人因病情惡化而接受心肺復甦術急救，卻仍然急救無效。我們回顧一些文獻報告，並且討論奴卡氏菌感染症之危險因子及臨床表現之症狀，此外也討論其診斷方法以及治療。

關鍵字

肺部奴卡氏菌感染症 ； 腦膿瘍

並列摘要

Nocardiosis is an uncommon disease in humans, and is considered an opportunistic infection which characteristically develops in immunocompromised persons. We report a patient with chronic obstructive pulmonary disease (COPD) with acute exacerbation, who had been treated with long-term corticosteroids. About seven days after admission, the patient developed high fever and bilateral pneumonia. Unfortunately, acute respiratory failure and multiple brain abscesses developed during hospitalization. Gram’s staining of deep-suctioned sputum revealed Nocardia species. Empirical antibiotics were then changed to trimethoprim-sulfamethoxazole (TMP-SMZ) and minocycline for pulmonary nocardiosis, and ceftriaxone for brain abscess. The condition of the central nervous system (CNS) still worsened, despite the fact that the pneumonic patch was resolving under the appropriate antibiotic therapy. Cardiopulmonary resuscitation was performed subsequently, on the 38th hospitalization day, but in vain. The relevant literature is reviewed, including the risk factors, clinical symptoms, diagnosis, and management of nocardiosis.

並列關鍵字

pulmonary nocardiosis ； brain abscess