Pulmonary Nocardiosis in a Multiple Myeloma Patient Treated with Proteasome Inhibitors

摘要

Patient: Male, 71 Final Diagnosis: Pulmonary nocardiosis Symptoms: Cough ? dyspnea ? fever Medication: Carfillzomib Clinical Procedure: Bronchoscopy Specialty: Infectious Diseases Objective: Rare co-existance of disease or pathology Background: The use of proteasome inhibitors like Bortezomib to treat multiple myeloma has been associated with increased rates of opportunistic infections, including Nocardia , especially when lymphopenia is present. The prevalence or association of such infections with newer agents like Carfilzomib is not known. Case Report: A 71-year-old man with multiple myeloma presented with a 6-week history of respiratory symptoms and cyclic fevers. He was undergoing chemotherapy with Carfilzomib. Work-up revealed severe lymphopenia and a CT chest showed multiple lung nodules and a mass-like consolidation. He underwent a bronchoscopy, and respiratory cultures grew Nocardia species. He responded well to intravenous antibiotics with resolution of symptoms and CT findings. Conclusions: With the introduction of newer agents like Carfilzomib for the treatment of multiple myeloma, clinicians must maintain a high degree of suspicion for opportunistic infections to achieve early diagnosis and treatment.