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Case Reports in Pulmonology
Volume 2012, Article ID 758630, 5 pages
http://dx.doi.org/10.1155/2012/758630
Case Report

Allergic Broncho Pulmonary Aspergillosis Complicated by Nocardiosis

1Department of Medicine, PGIMER & Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India
2Department of Medical Mycology, V.P. Chest Institute, University of Delhi, Delhi 110007, India

Received 19 September 2012; Accepted 12 December 2012

Academic Editors: D. Franzen, M. Ip, and S. A. McGrath-Morrow

Copyright © 2012 Brijesh Sharma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe a 70-year-old male with a history of diabetes mellitus, hypertension, and asthma who presented with increasing breathlessness for 5 months. He was diagnosed to have allergic bronchopulmonary aspergillosis (ABPA) by serological and radiographic criteria. He was treated with steroids and itraconazole. After initial improvement, he developed fever with cough and mucopurulent sputum. X-ray chest revealed multiple cavities with air fluid level. Patient was treated with antibiotics without any response. Sputum was negative for acid fast bacilli (AFB). Sputum culture for bacteria and fungus did not reveal any significant growth; however a delayed growth of Nocardia was noted on fungal plates. Modified Ziehl Nelsen stain was positive for AFB. Patient was treated with cotrimoxazole. We discuss the serological and radiological criteria of ABPA, presentation and treatment of nocardia pulmonary infection and other possible causes of necrotizing pneumonia in immunocompromised settings.