title: Pulmonary nocardiosis in an immunocompetent patient with COPD: the role of defective innate response.
abstract: OBJECTIVE
  Pulmonary nocardiosis is an uncommon opportunistic infection affecting mainly immunocompromised patients. We herein present a case of nocardiosis without profound underlying immunodeficiency.
  
  
  BACKGROUND
  A female, 84-years' old patient with stage IV chronic obstructive pulmonary disease (COPD) is presented. No profound causes of immunodeficiency existed, such as HIV infection, diabetes mellitus, malignancy, alcoholism, chemotherapy or previous corticosteroid intake. The patient recovered after treatment with trimethoprim/sulfamethoxazole for 6 months.
  
  
  RESULTS
  One year after infection resolution, stimulation of the patient's blood monocytes with Nocardia antigens revealed defective production of tumor necrosis factor-alpha, interleukin (IL)-6 and IL-17.
  
  
  CONCLUSIONS
  We provide preliminary evidence for a link between defective innate immune responses and predisposition for Nocardia infections. Further studies must be conducted in order to fully investigate this mechanism of infection acquisition.
authors.affiliation: 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini st., Haidari, Athens 12462, Greece. Kontoloi@otenet.gr
authors.forename: Marina
authors.initials: M
authors.lastname: Kontogiorgi
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Opsimoulis
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Athina
authors.initials: A
authors.lastname: Savva
authors.forename: Vasiliki E
authors.initials: VE
authors.lastname: Kalodimou
authors.forename: Elina
authors.initials: E
authors.lastname: Belesiotou
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giamarellos-Bourboulis
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007113:Immunity, Innate; D007121:Immunocompetence; D020381:Interleukin-17 / Q000096:biosynthesis; D015850:Interleukin-6 / Q000096:biosynthesis; D008168:Lung / Q000000981:diagnostic imaging; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000000981:diagnostic imaging / Q000209:etiology*; D009894:Opportunistic Infections; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology; D011859:Radiography; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
chemical_list: D020381:Interleukin-17; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: COPD; IL-17; IL-6; Nocardiosis; TNFα