title: Frequent exacerbation of pulmonary nocardiosis during maintenance antibiotic therapies in a hematopoietic stem cell transplant recipient.
abstract: We describe a rare case of recurrent pulmonary nocardiosis (PN) in a hematopoietic stem cell transplant recipient. The patient developed Nocardia farcinica infection while receiving corticosteroid and cyclosporine for the treatment of bronchiolitis obliterans, probably due to chronic graft-versus-host disease (cGVHD). The patient responded well to the initial treatment with meropenem, but PN recurred 3 times during oral maintenance therapies using different antibiotics, which were chosen on the basis of the results of in vitro susceptibility testing against N farcinica Minocycline, amoxicillin/clavulanate, and levofloxacin were not effective as oral maintenance therapies. Frequent exacerbation of PN was considered to have resulted from the low blood concentration of these antibiotics, and decreased gastrointestinal absorption, probably due to cGVHD, might have been the underlying problem.
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kakihana
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Ohashi
authors.forename: Mari
authors.initials: M
authors.lastname: Iguchi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Negishi
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Minori
authors.initials: M
authors.lastname: Shitara
authors.forename: Misao
authors.initials: M
authors.lastname: Honma
authors.forename: Hideki
authors.initials: H
authors.lastname: Akiyama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009615:Nocardia; D009617:Nocardia Infections / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018410:Pneumonia, Bacterial / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents