title: Pulmonary nocardiosis concurrent with Pneumocystis carinii pneumonia in two patients undergoing immunosuppressive therapy.
abstract: Two cases with concomitant pulmonary nocardiosis and Pneumocystis carinii pneumonia are described. The first patient developed pneumonia 3 months after heart transplantation while undergoing standard immunosuppressive therapy with cyclosporin, azathioprine and prednisone. The second patient was treated with chemotherapy and subsequent radiotherapy of the mediastinum for a malignant epithelial tumour. He also received prednisone for paraneoplastic dermatomyositis. Chest X-rays of both patients showed a bilateral interstitial pattern and broncho-alveolar lavage revealed P. carinii. Additional dense and localised pulmonary infiltrates led to suspicion of a further infectious agent, namely, Nocardia asteroides, which was isolated from both patients. Since nocardiosis calls for prolonged treatment, extensive diagnostic measures are needed for its early detection.
authors.affiliation: Department of Internal Medicine, University Hospital, Zürich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Perschak
authors.forename: J
authors.initials: J
authors.lastname: Gubler
authors.forename: R
authors.initials: R
authors.lastname: Speich
authors.forename: E
authors.initials: E
authors.lastname: Russi
mesh_terms: D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000628:therapy; D008875:Middle Aged; D009617:Nocardia Infections / Q000150:complications* / Q000188:drug therapy; D009616:Nocardia asteroides; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000188:drug therapy; D013411:Sulfadiazine / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination