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Abstract
Case Report
Pulmonary nocardiosis with solitary brain stem abscess
Masahiro Onishia Tetsu Kobayashia Atsushi Tomarua Yoshinori Takahashia Kentaro Fujiwaraa Masahito Urawaa Takehiro Takagia Hiroyasu Kobayashia Gabazza Estebanb Osamu Taguchia
aDepartment of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine
bDepartment of Immunology, Mie University Graduate School of Medicine
ABSTRACT
A 64-year-old woman with pemphigus was receiving treatment with steroids (prednisolone, 20 mg/day). The laboratory analysis revealed positive anti-Ach-R antibody, and thymoma with paraneoplastic pemphigus was diagnosed. Surgical resection of thymoma was canceled because preoperative chest computed tomography showed pulmonary nodules on the right S2 and left S8 bronchial segments. End-bronchial washing was performed to culture the sample and rule out infection, but no pathogenic microbe was identified. Empiric antibiotic therapy was started. During the clinical follow-up, she complained of sensory impairment of the left upper limb, stagger, and diplopia. Brain magnetic resonance imaging revealed a brain stem abscess. During the same period, sputum culture was positive for Nocardia, and pulmonary nocardiosis was diagnosed. A change of antibiotics resulted in complete control and resolution of the lung and brain lesions.
KEYWORDS
Pulmonary nocardiosis Brainstem abscess Thymoma
Received 28 Aug 2013 ／ Accepted 12 Nov 2014
AJRS, 4(2): 194-199, 2015
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