抄録
A forty five year-old man was transferred to our hospital because of persistent high fever and dyspnea. The patient had been on various antibiotics and steroids for the treatment of fever of unknown etiology after nasal polypectomy. The chest X-ray film on admission showed diffuse interstitial infiltration over both lung fields and a thick-walled cavity in the left middle lung field. As laboratory data did not yield a definitive diagnosis, transbronchofiberscopic lung biopsy and tube aspiration of the cavity were performed simultaneously.
Specimens of the biopsied lung revealed interstitial pneumonia and included enlarged cells with characteristic nuclear inclusion bodies, which were determined to be of cytomegalovirus origin by immunofluorescence. Direct staining of the aspirated material showed Gram-positive hyphae with branching characteristic of Nocardia asteroides which was confirmed subsequently by culture.
Treatment with sulfomethoxazole (2.4g/day) and trimetprim (480mg/day) led to disappearance of the cavity in a month.
In most cases of both cytomegalovirus pneumonia and pulmonary nocardiosis infection, definitive diagnosis has been made from postmortem specimens and few cases have been diagnosed before death by lung biopsy or needle aspiration. To the authors' knowledge this is the first report of such a case diagnosed by these procedures in Japan. Appropriate treatment was initiated after the establishment of diagnosis, with a successful outcome.
