A Case of Pulmonary Sequestration and Cystic Bronchiectasis Associated with Nocardia Infection

Abstract

Background. We report a case of pulmonary sequestration and cystic bronchiectasis associated with Nocardia infection. Case. A 46-year-old man was referred for further evaluation of an infected pulmonary cyst. Nocardia was detected in a sputum sample by Gram staining, but despite treatment for 2 years, his respiratory symptoms recurred. Because the lesion was confined to the right lower lobe of the lung, we performed surgical excision. Contrast-enhanced computed tomography (CT) performed before surgery showed aberrant arteries entering the right lower lobe from the descending aorta. This finding led to the diagnosis of pulmonary sequestration complicated by Nocardia infection. After undergoing right lower lobectomy by video-assisted thoracic surgery, the respiratory symptoms improved and have not recurred in 5 years. Conclusion.Nocardia is an opportunistic pathogen. Pulmonary structural abnormalities have been reported to be risk factors for pulmonary infection; however, Nocardia infection of a pulmonary sequestration is very rare. Contrast-enhanced CT should be performed when treatment refractory Nocardia infection is localized in the mediastinal side of the lower lobe, and pulmonary sequestration cannot be ruled out.