通讯作者: 闫秋瑾, qiujinyanl11@163.com

DOI：10.12201/bmr.202610.00054

A Case Report of Pulmonary Nocardiosis in a Diabetic Patient with Heart Failure Presenting Initially with Gastrointestinal Bleeding

• 摘要：肺奴卡菌病系由奴卡菌属诱发的肺部亚急性至慢性化脓性炎症，多见于免疫抑制宿主。因其临床表征与影像学特征缺乏特异性，极易造成诊疗延迟。本文报道一例56岁男性病例，该患者既往罹患2型糖尿病、冠状动脉粥样硬化性心脏病及消化性溃疡伴出血史。入院初期，其基础疾病症状掩盖了肺部感染征象；影像学检查显示左肺软组织密度影伴空洞形成。因经验性抗感染治疗无效，遂行超声引导下经皮肺穿刺抽吸脓液，经培养及分子生物学鉴定，最终确诊为乔治教堂奴卡菌（Nocardia farcinica）感染。治疗方案初选亚胺培南联合复方磺胺甲噁唑(SMZ-TMP)，后转为长期口服磺胺类药物维持，患者病情显著改善。本案例表明，在合并糖尿病等潜在免疫缺陷患者中，肺奴卡菌病起病隐匿且非典型，常被急性危重并发症所遮蔽，致使诊断滞后。本研究强调，面对疑难肺部病变，临床医师应高度警惕机会性感染可能，积极借助侵入性手段获取标本并结合先进微生物鉴定技术以明确病原；同时，也为伴随心肾功能不全患者的抗感染策略制定提供了宝贵的循证医学依据。

  关键词： 肺奴卡菌病；合并症；磺胺类药物; ; 

   

  Abstract: Pulmonary nocardiosis is a subacute to chronic suppurative pulmonary inflammation caused by *Nocardia* species, predominantly seen in immunocompromised hosts. Due to the non-specific clinical manifestations and imaging features, delayed diagnosis and treatment are common. We report a case of a 56-year-old male with a past medical history of type 2 diabetes mellitus, coronary atherosclerotic heart disease and peptic ulcer complicated with hemorrhage. At admission, symptoms of underlying diseases masked the signs of pulmonary infection. Imaging examination revealed a soft-tissue density lesion with cavity formation in the left lung. Empirical anti-infective therapy failed. Ultrasound-guided percutaneous lung puncture was performed to aspirate purulent fluid. Culture and molecular biological identification confirmed the infection caused by *Nocardia farcinica*. The initial regimen consisted of imipenem combined with trimethoprim-sulfamethoxazole (SMZ-TMP), followed by long-term oral sulfonamide maintenance therapy, and the patient achieved significant clinical improvement. This case demonstrates that pulmonary nocardiosis in patients with underlying immunodeficiency such as diabetes mellitus has an insidious and atypical onset. Pulmonary infectious signs are often obscured by acute severe complications, leading to delayed diagnosis. This study highlights that clinicians should maintain high vigilance for opportunistic infections when encountering unexplained pulmonary lesions. Invasive sampling combined with advanced microbial identification techniques should be applied to identify pathogens. Meanwhile, this case provides valuable evidence for anti-infective strategy formulation in patients complicated with cardiac and renal insufficiency.

  Key words: Pulmonary nocardiosis; comorbidity; sulfonamides

  提交时间：2026-10-26

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2026-08-30	10.12201/bmr.202610.00054V1	下载

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