trimethoprim--sulfamethoxazole-drug-combination and Sarcoidosis--Pulmonary

Infectious complications are rarely observed in the course of sarcoidosis. Only small series or cases reports of infection are described in sarcoidosis. Corticosteroids-induced immune suppression, pulmonary fibrosis and T-CD4 lymphopenia, are often present. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. We report a case of pulmonary nocardiosis in a patient with sarcoidosis followed for pulmonary fibrosis receiving corticosteroids. During the investigation of pyrexia and dyspnea, evidence of Nocardia spp. infection was found in the bronchial secretions. Six months of trimethoprim/sulfamethoxazole therapy ensured further resolution of this pleuropulmonary infection. Pulmonary nocardiosis is exceptional in sarcoidosis and mainly occur, in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.

Topics: Adult; Anti-Infective Agents; Female; Humans; Nocardia Infections; Radiography, Thoracic; Sarcoidosis, Pulmonary; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is a rare, mixed suppurative and granulomatous, bacterial infection that can affect various organs, but most commonly lungs. Clinical manifestation is usually uncharacteristic; can mimic fungal, parasitic and mycobacterial infections or malignancy. Presentation can be also similar to that of the other granulomatous diseases, among them sarcoidosis. We present an unusual case of disseminated nocardiosis in a patient diagnosed before with sarcoidosis and treated with glucocorticoids. Clinical symptoms initially mimicked exacerbation of pulmonary sarcoidosis. The course of disease was severe.

Topics: Abscess; Adult; Anti-Infective Agents; Diagnosis, Differential; Disease Progression; Glucocorticoids; Humans; Male; Mediastinal Diseases; Methylprednisolone; Nocardia Infections; Opportunistic Infections; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A case of severe dyspnea, hypercalcemia and renal failure secondary to sarcoidosis is reported. The clinical diagnosis of sarcoidosis in a 48-year-old man was confirmed by histology and cytology. Transiently decreased numbers of CD4+ T cells (282/microliter) indicated impaired immunity in the absence of HIV-infection during the acute phase of the disease. Surprisingly, numerous "trophozoites" of Pneumocystis carinii were detected by immunofluorescence staining and PCR in the bronchoalveolar fluid indicating infection or colonization of the lungs. Corticosteroid therapy was administered together with trimethoprim-sulfamethoxazole and rapidly reduced elevated serum calcium and creatinine concentrations. Since airborne person-to-person transmission of P. carinii to susceptible individuals might be possible, patients with sarcoidosis could be a previously unrecognized reservoir for P. carinii distribution in hospitals and in the community at large.

Topics: CD4 Lymphocyte Count; Drug Therapy, Combination; Humans; Hypercalcemia; Immune Tolerance; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis; Prednisone; Renal Insufficiency; Sarcoidosis, Pulmonary; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Meropenem; Neutrophils; Nocardia Infections; Sarcoidosis, Pulmonary; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination