TY - JOUR T1 - Pulmonary nocardiosis in immunocompetent patients: can COPD be the only risk factor? JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 210 LP - 212 DO - 10.1183/09059180.00002211 VL - 20 IS - 121 AU - F. Rivière AU - M. Billhot AU - C. Soler AU - F. Vaylet AU - J. Margery Y1 - 2011/09/01 UR - http://err.ersjournals.com/content/20/121/210.abstract N2 - To the Editor:Pulmonary nocardiosis is a rare disorder that mainly affects immunocompromised patients. Several risk factors have been identified, such as corticosteroid therapy, chronic obstructive pulmonary disease (COPD), cystic fibrosis and bronchiectasis. Diagnosis of nocardiosis is difficult as bacteriological culture can be problematic. However, if observations are atypical, clinicians should consider Nocardia in immunocompetent patients, particularly when the patient is also suffering from COPD. Herein, we ask whether COPD alone is a risk factor for pulmonary nocardiosis.We report the case of a 71-yr-old female smoker suffering from COPD who had not received inhaled or oral (bolus or long-term) corticosteroid therapy. She had suffered from bronchiectasis after pulmonary tuberculosis 60 yrs previously. She presented to the hospital with an exacerbated chronic cough that had lasted several months and chronic fever, with no weight loss. Prior to admission, amoxicillin followed by spiramycin therapy was not effective. Laboratory evaluation showed hyperleukocytosis (14,130 cells per mm3, with 10,753 polynuclear neutrophils per mm3) and C-reactive protein 75 mg·L−1 (normal range <5 mg·L−1), with no renal failure or hepatic biological abnormalities. Her gamma globulin level was normal (11.7 g·L−1). Aspergillosis serology and the tuberculin intradermal reaction were negative; sputum examination was sterile, without Mycobacterium or Aspergillus. Chest radiography showed linear opacity of the right upper lobe with bronchiectasis and excavated opacity in the right upper lobe. A computed tomography scan of the chest revealed bronchiectasis with a thickened lining and cystic dilatation of the right upper lobe, as well as diffuse centrolobular micronodules in all lobes of the right lung (fig. 1). … ER -