Pulmonary co-infection with Nocardia and Aspergillus in a patient with adult-onset Still's disease receiving steroids and tacrolimus.
Patients on immunosuppression are at risk of unusual infections. We present a man diagnosed to have adult-onset Still's disease who, on high-dose oral steroid and tacrolimus, developed a cavitating pneumonia due to co-infection with Aspergillus flavus and Nocardia. Timely diagnosis and institution of appropriate therapy resulted in a favourable clinical outcome. Such co-infection in a patient receiving tacrolimus is rare in the published literature. This case serves to emphasise the need to be vigilant for unusual infections in patients who are immunosuppressed, either due to drugs or underlying disease condition.
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Durga Prasanna
DP
Misra
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Jyoti Ranjan
JR
Parida
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Abhra Chandra
AC
Chowdhury
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Vikas
V
Agarwal
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D060085:Coinfection / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D013902:Radiography, Thoracic / Q000379:methods; D013256:Steroids / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D016559:Tacrolimus / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus