Presentation
A patient with advanced lung adenocarcinoma receiving systemic corticosteroid therapy as an anti-edema treatment of brain metastasis.
Patient Data
Evidence of necrotizing pneumonia and multiple bilateral pulmonary nodular lesions of different sizes, most of them cavitated. Large left hydropneumothorax and adjacent empyema necessitatis. A CT scan also reveals focal splenic lesions. Bilateral breast prosthesis.
Case Discussion
Pulmonary nocardiosis is a severe opportunistic infection characterized by cavitary lesions that mainly affect immunocompromised patients. In our case, it was caused by prolongated corticosteroid therapy for brain metastasis of lung adenocarcinoma.
The infection extended outside the lung into the pleural space and thoracic wall, presenting as empyema necessitatis. The most common cause of this rare complication is Mycobacterium tuberculosis. Nocardiosis as an etiology of empyema necessitatis is occasionally reported in the medical literature. In this case, the culture was positive for Nocardia otitidiscaviarum.
This case is submitted in collaboration with Dra. Noemí Cañete.
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