Thursday, September 08, 2005

More Follow up: Recurrent Pneumonia

Here's some more follow up on the case I posted last week (9/1/05:

The BAL fungal culture ended up growing out nocardia asteroides.
Based on the preliminary report from the micro lab I obtained a head CT to exclude CNS involvement, which was negative. I started her on high dose bactrim which ended up being 1 DS tab qid and followed CBC,chem 7, LFT's to monitor for toxicity.

After 8 weeks of high dose bactrim her symptoms significantly improved and the basilar opacities on her CXR have improved. I lowered her bactrim dosage by 50% to 1 DS tab bid which I plan to continue for at least another 6 months.

She still has diffuse interstitial opacities on her CXR, so it's likely that she does have underlying ILD and the nocardia was a complication of her steroid therapy. One radiologist felt that all the changes could be due to a chronic nocardia infection, but I would have expected more systemic symptoms and involvement if that were the case. I posted her followup CXR below.

Any thoughts, comments?

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