title: Unusual mixed infection of thoracic empyema caused by Mycobacteria tuberculosis, nontuberculosis mycobacteria and Nocardia asteroides in a woman with systemic lupus erythematosus.
abstract: We report a 45-year-old woman of systemic lupus erythematosus (SLE) with thoracic empyema that was unusually infected by Mycobacterium tuberculosis (MTB), Nontuberculosis mycobacteria (NTM) concomitant with Nocardia asteroides. After a combined treatment of cotrimoxazole, clarithromycin and anti-tuberculosis drugs with a short-term of intravenous immunoglobulin (IVIG), the patient recovered from the critical illness. On the basis of the results in this case, we recommend a thorough survey of the probably concomitant infections of MTB and NTM in an immunocompromised patient with a known N. asteroid infection. In addition, an adjuvant intravenous immunoglobulin therapy may have beneficial effect in the control of infections in an SLE patient.
authors.affiliation: Department of Intensive Care Medicine, Chi-Mei Medical Center, 901 Chung Hwa Rd, 710 Yungkang City, Tainan County, Taiwan.
authors.forename: Heng-Ching
authors.initials: HC
authors.lastname: Huang
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Yu
authors.forename: Chi-Chang
authors.initials: CC
authors.lastname: Shieh
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.forename: He-Hsiung
authors.initials: HH
authors.lastname: Cheng
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016724:Empyema, Pleural / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D004654:Empyema, Tuberculous / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D013624:Taiwan; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000995:Antitubercular Agents; D016756:Immunoglobulins, Intravenous; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017291:Clarithromycin