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Pulmonary nocardiosis developed in a hematopoietic stem cell transplant recipient with bronchiolitis obliterans.

Ruriko Nishida, Yasuo Mori, Hiromi Iwasaki, Takahito Tokuyama, Kenjiro Kamezaki, Yoji Nagasaki, Hideyo Oka, Kohta Miyawaki, Noriyuki Saito, Katsuto Takenaka, Naoki Harada, Toshihiro Miyamoto, Takanori Teshima, and Koichi Akashi

Intern Med 49(14):1441-4 (2010) PMID 20647664

The chronic graft-versus-host disease often requires unceasing immunosuppressive therapy (IST), which increases a risk of infectious complications in hematopoietic stem cell transplantation (HSCT) recipients. We report an adult T-cell leukemia/lymphoma case who developed pulmonary nocardiosis, a rare pulmonary complication, after allogeneic HSCT despite administration of the prophylactic trimethoprim-sulfamethoxazole (TMP/STX). The inhaled corticosteroid in addition to systemic IST had been started for bronchiolitis obliterance 4 months prior to nocardiosis development. The patient was successfully treated with an increased dose of TMP/STX combined with meropenem. Transplantation physicians should keep this rare pulmonary complication in mind during sustained IST.

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