Pulmonary nocardiosis with superior vena cava syndrome in HIV-infected patient: A rare case report in the world

抄録

Pulmonary nocardiosis is a common disease among HIV-infected patients. In most cases, the disease progresses slowly. Here, we present a case whose disease progressed rapidly. A 35-year-old female with AIDS and superior vena cava (SVC) syndrome who was lost to follow-up visited our hospital. She presented with a chronic non-productive cough and her CD4 count was 33 (4%). Her chest x-ray showed opacity in the right upper lobe of her lung and her sputum acid-fast stain was negative. Anti-tuberculosis agents were prescribed. Two weeks later, superficial vein dilatation appeared on her chest wall and her chest x-ray became worse. CT chest showed a mass in her right lung. The size of the mass was 9.6 x 9.8×8.3 cm. The mass was heterogeneous. Necrotic mediastinal nodes nearly obliterated the SVC. Gram-positive beading and branching filamentous organisms were identified in her sputum by modified acid-fast stain. She was diagnosed with pulmonary nocardiosis. This diagnosis was confirmed by culture. She had Nocardia beijingensis with SVC syndrome. She responded to treatment. After two weeks of parenteral agents, we switched her to oral trimethoprim/sulfamethoxazole which was later followed by antiretroviral agents.