Klin Padiatr 2022; 234(05): 323
DOI: 10.1055/s-0042-1754458
Abstracts
Orals
Kasuistiken / Best-of-Abstracts

Pleuropneumonia caused byNocardia cyriacigeorgica in a 14-year-old girl with PCD

RM Urbantat
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
2   German Center for Lung Research, Berlin, Germany
,
C Pioch
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
,
N Ziegahn
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
,
M Stegemann
3   Charité – Universitätsmedizin Berlin, Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany
,
M Stahl
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
2   German Center for Lung Research, Berlin, Germany
4   Berlin Insitute of Health, Berlin, Germany
,
MA Mall
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
2   German Center for Lung Research, Berlin, Germany
4   Berlin Insitute of Health, Berlin, Germany
,
J Röhmel
1   Charité – Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, Germany
› Author Affiliations
› Further Information
Also available at
 

Introduction Primary ciliary dyskinesia (PCD) is a rare genetic disease that leads to a disruption of the mucociliary clearance. Thus, pathogens are less effectively removed from airways and patients are more susceptible to respiratory infections. Here we present the first case of acute pulmonary nocardiosis in a PCD patient.

Case report A 14-year old Caucasian female with PCD (genotype: DNAAF1, c.1349dupC homozygous, nNO = 6nl/min, TEM: ODA and IDA missing) presented with dyspnea, fever and left-sided thoracic pain and highly elevated markers of inflammation. The chest-X-ray and follow-up MRI showed a left lower lobe pneumonia. We started an empiric antibiotic therapy with piperacillin/tazobactam. Five days of this treatment did not yield to clinical improvement. A pleura ultrasound revealed left sided pleural effusion. The sputum culture now grew Nocardia cyriacigeorgica. The diagnosis of a nocardial pleuropneumonia was confirmed by bronchoscopy with bronchoalveolar lavage. The treatment was adapted to IV meropenem and high-dose trimethoprim/sulfamethoxazole (TMP/SMX; TMP dose: 20mg/kg/day) which caused nausea and vomiting. Therefore, the TMP dose was reduced to 13,6mg/kg/day for better tolerability. This treatment was continued for 6-weeks followed by continuous oral treatment with TMP/SMX (3x160/800mg & 1x100mg doxycycline/day). 9 months after initial treatment, Nocardia cyriacigeorgica was no longer detectable in sputum and lung function testing normalized (FEV1=94.1%, LCI2.5 =7.03).

Conclusion This is the first report of a nocardia pleuropneumonia in a PCD patient. High dose TMP/SMX combined with meropenem successfully treated Nocardia cyriacigeorgica and should be considered as a treatment option.



Publication History

Article published online:
21 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany