全肺洗浄後病勢が安定した自己免疫性肺胞蛋白症患者に発症した肺ノカルジア症の1例

抄録

Autoimmune pulmonary alveolar proteinosis (APAP) is known to be associated with a high risk of infections, although the underlying mechanism remains unclear. Herein, we report a case of pulmonary nocardiosis associated with APAP that stabilized after therapeutic whole-lung lavage (WLL). The patient was a 75-year-old man; he was diagnosed as having APAP in 20XX-3 and his condition improved with WLL. A follow-up chest computed tomography (CT) in 20XX-1 revealed a 7-mm nodular shadow in the upper lobe of the left lung, and two CT-guided percutaneous transthoracic needle biopsies (CT-PTNB) were performed, the first in 20XX-1 and the second in 20XX. Although the first CT-PTNB did not yield a conclusive diagnosis, culture of the second biopsy specimen grew Nocardia sp., and we diagnosed the patient as having pulmonary nocardiosis secondary to APAP. He was treated with meropenem for the first 9days andsulfamethoxazole-trimethoprim for 6 months, and follow-up CT revealed a decrease in the size of the nodule. Physicians should bear in mind the possibility of nocardiosis as a complication in patients with APAP even when the disease becomes stable after treatment by WLL.