A case of allergic bronchopulmonary aspergillosis complicated by nocardiosis and staphylococcus aureus infection

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by complex immunological reactions to Aspergillus fumigatus [1,2]. High-resolution computed tomography (HRCT) of the chest is the imaging modality of choice for the diagnosis of ABPA [3].

Long-term oral glucocorticoid therapy is often required to prevent the progression of lung damage in ABPA [4]. Risk of acquiring secondary infections by organisms like Nocardia; staphylococcus aureus is significantly increased in patients of ABPA, who are on steroid therapy. Nocardiosis should be strongly suspected in patients who are immunocompromised and have features of severe pneumonia with nodular or fluffy infiltrates on the chest X-ray. Accentuation of zonal differences in ventilation and perfusion in ABPA patients leads to susceptibility to S. aureus infection and subsequent damage. Alternatively, S. aureus may have a predilection to occur in the lung with upper lobe damage which coincidentally occurs in both conditions.

Nocardiosis is a life-threatening infection with a protracted course, and delayed diagnosis. We report this case of Nocardia Sp. and staphylococcus aureus co-infection in a middle-aged male patient diagnosed with ABPA, so as to make the treating physicians more vigilant – as an early diagnosis and treatment of Nocardiosis has a better prognosis.