Nocardiosis presenting as an anterior mediastinal mass in a patient with sarcoidosis.
We report a patient with tissue-proven sarcoidosis receiving adrenocorticosteroid medication, who developed an enlarging mediastinal mass. Transcutaneous needle biopsy of the mass yielded pus which grew Nocardia asteroides on culture. Pleural effusion, bronchoesophageal fistula and brain nocardia metastases occurred. All evidence of active infection cleared with sulfa therapy. An enlarging mass in a patient with sarcoidosis unresponsive to corticosteroid therapy should provoke studies for other causes of mediastinal disease, including opportunistic infections.
Jastrzembski
Stasia A
SA
Division of Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, Box 1232, One East 100th Street, New York, NY 10029, USA.
Teirstein
Alvin S
AS
Herman
Steven D
SD
DePalo
Louis R
LR
Lento
Patrick A
PA
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D009617:Nocardia Infections / Q000175:diagnosis / Q000209:etiology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D011241:Prednisone / Q000009:adverse effects*; D012507:Sarcoidosis / Q000150:complications* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D011241:Prednisone