면역억제제 치료 중인 류마티스 관절염 환자에서 발생한 Streptococcus salivarius 및 Nocardia 폐렴 1예
Streptococcus salivarius pneumonia with pulmonary nocardiosis in a rheumatoid arthritis patient treated with immunosuppressants
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초록
Streptococcus salivarius는 상재균으로 감염의 원인으로는 간과되는 경우가 많았으나 최근 이 균에 의한 심각한 감염이 일부 환자에서 드물게 보고되어 왔다. Nocardia 감염 또한 드문 기회감염으로 스테로이드 치료, 악성종양, 장기 및 동종골수이식, 후천성면역결핍증 등 면역억제 환자에서 위험이 높은 질환이다. 본 증례에서는 스테로이드와 methtraxate, leflunomide를 투여 중인 류마티스 관절염 환자에서 발생한 다발성 종괴양 폐침윤에 대해서 기관지폐포세척액과 경기관지폐생검, 경피적미세침흡인 폐생검 조직의 배양검사를 통하여 Streptococcus salivarius 폐렴과 동반된 폐 Nocardia 감염을 진단하였으며, 항생제 치료로 증상과 방사선 소견이 모두 호전되어 이를 문헌고찰과 함께 보고한다.
Abstract
Streptococcus salivarius is a Gram-positive organism that belongs to the viridians group of streptococci. It is a relatively non-virulent bacterium that is part of the normal flora. It is rarely isolated from blood and is usually considered a contaminant. Nevertheless, S. salivarius may cause life-threatening infections, especially in immunocompromised hosts. There have been relatively few reports of S. salivarius pneumonia. Nocardiosis is also a rare opportunistic infection. Pulmonary nocardiosis is difficult to diagnose and, consequently, the diagnosis is often delayed. We report an unusual presentation with multiple pulmonary mass-like consolidations caused by a mixed infection of S. salivarius and Nocardia sp. in a 58-year-old man with rheumatoid arthritis who was taking oral corticosteroid, methotrexate, and leflunomide. The patient’s symptoms and radiographic findings improved after six weeks of antibiotic therapy.
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