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Vol.51 No.3 contents | Japanese/English |
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- Case Report -
An HIV Carrier with a Postoperative Diagnosis of Lung Nocardiosis Concomitant with Lung Adenocarcinoma
Katsuhito Ueno1,2, Makoto Tanaka1, Chiyoko Kohno3, Mika Zaima3, Yoshihito Yamada3, Tetsuo Yamaguchi31Department of Thoracic Surgery, JR Tokyo General Hospital, Japan, 2Department of Cardiothoracic Surgery, Tokyo University, Japan, 3Department of Pulmonary Medicine, JR Tokyo General Hospital, Japan
Background. Lung nocardiosis is difficult to diagnose due to the non-specific clinical course. We report a rare case of an HIV carrier with a postoperative diagnosis of lung nocardiosis concomitant with lung adenocarcinoma. Case. A 59-year-old man presented with an abnormal shadow in the left lung detected on an annual medical check-up. He had no complaints of fever, and no abnormalities on biochemical or bacterial examinations. On chest computed tomography the mass was 45 mm in maximum dimension with direct invasion to the left main pulmonary artery. We also suspected a swollen hilar lymph node. Aspiration fluid and lavage cytology findings were positive for malignancy, and the tumor was diagnosed as lung adenocarcinoma (cT4N1M0, stage IIIA). The tumor reduced in size after 1 course of chemotherapy and his clinical stage was down graded to ycT2bN1M0, stage IIB, and therefore an operation was scheduled. Preoperative examinations revealed that he was an HIV carrier and his CD4 level was not particularly low, and therefore he underwent the operation as scheduled. We performed a left pneumonectomy with lymph node dissection and concomitant chest wall resection due to the tumor invasion of the left main pulmonary artery and the chest wall. Pathological examination and genetic analysis results indicated a diagnosis of massive necrotic epithelioid cell granuloma due to nocardia, and moderately differentiated acinar adenocarcinoma in a very small section of the hilum, but without lymph node metastasis or dissemination to the chest wall (pT1aN0M0, stage IA). Conclusion. When making a differential diagnosis of an indeterminant lung mass, we must consider the possibility of combined disease with inflammatory change and malignancy. Histological diagnosis is also mandatory before treatment, and it is necessary to consider the rare possibility of lung nocardiosis in cases of HIV carriers.
key words: Lung nocardiosis, HIV, Adenocarcinoma of the lung
Received: November 8, 2010
Accepted: April 11, 2011
JJLC 51 (3): 217-221, 2011
