Purulent Constrictive Pericarditis Caused by Nocardia asteroides
Authors: GEORGE P. SUSENS
Journal: Annals of Internal Medicine (1967)

Case Studies1 November 1967Purulent Constrictive Pericarditis Caused by Nocardia asteroidesGEORGE P. SUSENS, M.D., ABDUL AL-SHAMMA, M.D., JOHN C. ROWE, M.D., CHARLES C. HERBERT, M.D., MILTON L. BASSIS, M.D., GRANVILLE C. COGGS, M.D.GEORGE P. SUSENS, M.D.Search for more papers by this author, ABDUL AL-SHAMMA, M.D.Search for more papers by this author, JOHN C. ROWE, M.D.Search for more papers by this author, CHARLES C. HERBERT, M.D.Search for more papers by this author, MILTON L. BASSIS, M.D.Search for more papers by this author, GRANVILLE C. COGGS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-5-1021 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptInfection with Nocardia asteroides, although rare, is being reported with increasing frequency, in part, no doubt, because of improvement in methods of laboratory identification. Invasion by this fungus is a relatively common complication of steroid therapy and of malignant neoplastic disease (1-5). The organism usually affects the lung or brain, but almost any organ may be involved. The following case is reported because we believe it to be the first instance in the literature in which nocardial infection gave rise to purulent constrictive pericarditis and to emphasize the difficulty that may attend the diagnosis.CASE REPORTA 56-year-old white photographer...References1. MURRAYFINEGOLDFROMANWILL JFSMSDW: The changing spectrum of nocardiosis. A review and presentation of nine cases. Amer. Rev. Resp. Dis. 83: 315, 1961. MedlineGoogle Scholar2. WHITMOREGRESHAMGRAYSON DNGAMJ: Nocardiosis in anemic patients given steroids. J. Clin. Path. 14: 259, 1961. CrossrefMedlineGoogle Scholar3. KERBEL NC: Long-term steroid therapy of the nephrotic syndrome in an adult complicated by fatal nocardiosis. Canad. Med. Ass. J. 87: 129, 1962. MedlineGoogle Scholar4. HATHAWAYMASON BMKN: Nocardiosis. Study of fourteen cases. Amer. J. Med. 32: 903, 1962. CrossrefMedlineGoogle Scholar5. SALTZMANCHICKCONANT HAEWNF: Nocardiosis as a complication of other diseases. Lab. Invest. 11: 1110, 1962. MedlineGoogle Scholar6. EPPINGER H: Ueber eine neue pathogene Cladothrix und eine durch sie hervorgerufene Pseudotuberculosis (cladothrichica). Beitr. Path. Anat. 9: 287, 1890. Google Scholar7. NOCARD E: Note sur la maladie des boeufs de la Guadeloupe connue sous le nom de farcin. Ann. Inst. Pasteur (Paris) 2: 293, 1888. Google Scholar8. MAHVI TA: Disseminated nocardiosis caused by Nocardia brasiliensis. First case report in the United States. Arch. Derm. (Chicago) 89: 426, 1964. CrossrefMedlineGoogle Scholar9. DOORENJONG DEED: [Nocardiosis of the lungs.] (Dut.) Nederl. T. Geneesk. 107: 856, 1963. Google Scholar10. WILSONPLUNKETT JWOA: The Fungous Diseases of Man. The University of California Press, Berkeley, 1965, p. 143. CrossrefGoogle Scholar11. GRAYCHODOSHREINISCHHUNT JBSEW: A new, rapid concentration and differential culture technique for the primary isolation of mycobacteria and nocardia. Amer. Rev. Resp. Dis. 86: 657, 1962. MedlineGoogle Scholar12. GEORGAJELLOMCDURMONTHOSTY LKLCTS: The identification of Nocardia asteroides and Nocardia brasiliensis. Amer. Rev. Resp. Dis. 84: 337, 1961. MedlineGoogle Scholar13. SCHNEIDAUSHAFFER JDMF: Studies on nocardia and other actinomycetales. II. Antigenic relationships shown by slide agglutination tests. Amer. Rev. Resp. Dis. 82: 64, 1960. MedlineGoogle Scholar14. PIERKEELER ACRF: Extracellular antigens of Nocardia asteroides. I. Production and immunologic characterization. Amer. Rev. Resp. Dis. 91: 391, 1965. CrossrefMedlineGoogle Scholar15. KEELERPIER RFAC: Extracellular antigens of Nocardia asteroides. II. Fractionation and chemical characterization. Ibid., p. 400. Google Scholar16. DYSONSLACK JEJM: Improved antigens for skin testing in nocardiosis. I. Alcohol precipitates of culture supernates. Amer. Rev. Resp. Dis. 88: 80, 1963. Google Scholar17. AFFRONTI LF: Purified protein derivatives (PPD) and other antigens prepared from atypical acid-fast bacilli and Nocardia asteroides. Amer. Rev. Resp. Dis. 79: 284, 1959. Google Scholar18. PIER AC: Personal communication. Google Scholar19. SYMMERS WS: Histological examination in the diagnosis of deep-seated fungal infections, in Recent Advances in Clinical Pathology, Series III, edited by DYKE, S. C. J. & A. Churchill, Ltd., London, 1960, p. 312. Google Scholar20. MONSERRAT C: Pulmonary nocardiosis: report of a case. J. Philipp. Med. Ass. 12: 11, 1932. Google Scholar21. HATCHPOTEETE HBFH: A typical example of nocardiosis involving the lung and subcutaneous tissue. Ochsner Clin. Rep. 2: 57, 1956. MedlineGoogle Scholar22. ALESTRAGIROLAMI LM: Endocarditi da nocardie. Poliolinico [Med.] 44: 441, 1937. Google Scholar23. LYONSOWENAYERS CCRWB: Sulfonamide therapy in actinomycotic infections. Surgery 14: 99, 1943. Google Scholar24. HUTTERCOLLINS RVHS: The occurrence of opportunistic fungus infections in a cancer hospital. Lab. Invest. 11: 1035, 1962. MedlineGoogle Scholar25. HICKEYBERGLUND RCEM: Nocardiosis; aerobic actinomycosis with emphasis on the alimentary tract as a portal of entry. Arch. Surg. (Chicago) 67: 381, 1953. CrossrefGoogle Scholar26. CARLILEHOLLEYLOGAN WKKEGB: Fatal acute disseminated nocardiosis in a child. JAMA 184: 477, 1963. CrossrefMedlineGoogle Scholar27. CROSSBINFORD RMCH: Is Nocardia asteroides an opportunist? Lab. Invest. 11: 1103, 1962. MedlineGoogle Scholar28. WELSHRHOADESER JDJW: Disseminated nocardiosis involving the spinal cord. Case report. Arch. Intern. Med. (Chicago) 108: 73, 1961. CrossrefMedlineGoogle Scholar29. PENIKETTREES EJDL: Nocardia asteroides infection of the nasal lacrimal system. Amer. J. Ophthal. 53: 1006, 1962. CrossrefMedlineGoogle Scholar30. BUCHWALDBORDÁČOVÁ JJ: [Clinical and microbiological study of a rare case of nocardiosis.] (Cz.) Cesk. Derm. 39: 275, 1964. MedlineGoogle Scholar31. LÓPEZALES REINLEINRAMÍREZ GUEDESORTIZ MASLLORENS GEJMJF: [Nocardiosis.] (Sp.) Rev. Clin. Esp. 77: 20, 1960. MedlineGoogle Scholar32. FAILESPOSNEY DK: Systemic nocardiosis presenting as a breast abscess. Med. J. Aust. 1: 342, 1965. CrossrefMedlineGoogle Scholar33. CONNOLLYBURCHELL DCHB: Pericarditis: a ten year survey. Amer. J. Cardiol. 7: 7, 1961. CrossrefGoogle Scholar34. BOYLEPEARCEGUZE JDMLLB: Purulent pericarditis: review of literature and report of eleven cases. Medicine (Balt.) 40: 119, 1961. CrossrefGoogle Scholar35. WOLFFGRUNFELD LO: Pericarditis. New Eng. J. Med. 268: 419, 1963. CrossrefMedlineGoogle Scholar36. HERRMANNMARCHANDGREERHEJTMANCIK GREJGHMR: Pericarditis. Clinical and laboratory data of 130 cases. Amer. Heart J. 43: 641, 1952. CrossrefMedlineGoogle Scholar37. DUVALLCARBONE CPPP: Cryptococcus neoformans pericarditis associated with Hodgkin's disease. Ann. Intern. Med. 64: 850, 1966. LinkGoogle Scholar38. LAMBRETHSEN E: [Nocardiosis as a complication of leukemia.] (Dan.) Ugeskr. Laeg. 124: 767, 1962. MedlineGoogle Scholar39. SMITHMCALEERLAURIE WGRW: Nocardiosis in Australia. Med. J. Aust. 2: 534, 1963. CrossrefMedlineGoogle Scholar40. GREER AE: Disseminating Fungus Diseases of the Lungs. Charles C Thomas, Publisher, Springfield, Ill., 1962, p. 29. Google Scholar41. DEROM E: [Apropos of Nocardia asteroides infections.] (Fr.) Mem. Acad. Chir. (Paris) 89: 607, 1963. MedlineGoogle Scholar42. BRICENO MAAZPOLLAK TL: [Pulmonary nocardiosis and actinomycosis.] (Sp.) Mycopathologia 15: 358, 1961. CrossrefGoogle Scholar43. BRINE JA: Human nocardiosis: a developing clinical picture. Med. J. Aust. 1: 339, 1965. CrossrefMedlineGoogle Scholar44. CORNELLSHOOKHOFF AHB: Actinomycosis of the heart simulating rheumatic fever: report of 3 cases of cardiac actinomycosis with review of the literature. Arch. Intern. Med. (Chicago) 74: 11, 1944. CrossrefGoogle Scholar45. CHAPMANKAPLAN MGL: Cardiac involvement in coccidioidomycosis. Amer. J. Med. 23: 87, 1957. CrossrefMedlineGoogle Scholar46. WOOLEYHOSIER CFDM: Constrictive pericarditis due to Histoplasma capsulatum. New Eng. J. Med. 264: 1230, 1961. CrossrefMedlineGoogle Scholar47. STRAUSSKLIGMANPILLSBURY REAMDM: The chemotherapy of actinomycosis and nocardiosis. Amer. Rev. Resp. Dis. 63: 441, 1951. Google Scholar48. PEABODYSEABURY JWJH: Actinomycosis and nocardiosis. A review of basic differences in therapy. Amer. J. Med. 28: 99, 1960. CrossrefMedlineGoogle Scholar49. FREESEYOUNGSEALYCONANT JWWGWCNF: Pulmonary infection by Nocardia asteroides. Findings in eleven clinical cases. J. Thorac. Cardiov. Surg. 46: 537, 1963. CrossrefMedlineGoogle Scholar50. ANDERSENECKLUNDKELLOW BRREWF: Pulmonary alveolar proteinosis with systemic nocardiosis. A case report. JAMA 174: 28, 1960. CrossrefMedlineGoogle Scholar51. ANDRIOLEBALLASWILSON VTMGL: The association of nocardiosis and pulmonary alveolar proteinosis. A case study. Ann. Intern. Med. 60: 266, 1964. LinkGoogle Scholar52. BALLENGERGOLDRING CND: Nocardiosis in childhood. J. Pediat. 50: 145, 1957. CrossrefMedlineGoogle Scholar53. BERNSTEINCOOKPLOTNICKTENCZAR ILJEHFJ: Nocardiosis: three case reports. Ann. Intern. Med. 36: 852, 1952. LinkGoogle Scholar54. BIANCOJOHNSONMARTINNICHOLS AJEWWJDR: Nocardiosis without involvement of the pulmonary or central nervous system. Proc. Mayo Clin. 32: 119, 1957. MedlineGoogle Scholar55. BURBANKMORRIONECUTLER BTGSS: Pulmonary alveolar proteinosis and nocardiosis. Amer. J. Med. 28: 1002, 1960. CrossrefMedlineGoogle Scholar56. CARLSENHILLROWLANDS ETRBDT: Nocardiosis and pulmonary alveolar proteinosis. Ann. Intern. Med. 60: 275, 1964. LinkGoogle Scholar57. COTTONLLOYD REHE: Lipid pneumonia and infection with Nocardia asteroides complicating achalasia of the cardia. J. Path. Bad. 79: 251, 1960. CrossrefMedlineGoogle Scholar58. CROTTY JM: Systemic mycotic infections in Northern Territory Aborigines. Med. J. Aust. 1: 184, 1965. CrossrefMedlineGoogle Scholar59. CULLENSHARP CHME: Infection of wounds with Actinomyces. J. Bone Joint Surg. [Brit.] 33: 221, 1951. CrossrefGoogle Scholar60. CUPPEDWARDSCLEVE CMWMEA: Nocardiosis of the central nervous system: report of two fatal cases. Ann. Intern. Med. 52: 223, 1960. LinkGoogle Scholar61. CZAYKOWSKA K: [A case of tubercular pulmonary cirrhosis complicated by Nocardia asteroides infection in a child.] (Pol.) Pediat. Pol. 38: 203, 1963. MedlineGoogle Scholar62. DANOWSKICOOPERBRAUDE TSWMA: Cushing's syndrome in conjunction with Nocardia asteroides infection. Metabolism 11: 265, 1962. MedlineGoogle Scholar63. DOLANMCCULLOUGHGIBSON TFNBLE: Nocardiosis: report of two cases in children. Amer. J. Dis. Child. 99: 234, 1960. CrossrefGoogle Scholar64. DUBOSHIRSCH RJJG: Bacterial and Mycotic Infections of Man, 4th ed. J. B. Lippincott Co., Philadelphia and Montreal, 1965, p. 827. Google Scholar65. EICHOLDWRIGHT SRD: Nocardia asteroides effectively treated with concurrent steroid management of pemphigus vulgaris. J. Med. Ass. Alabama 28: 333, 1959. Google Scholar66. EPSTEINHOLDENFELDSHUHSINGER SMJJM: Unusual cause of spinal cord compression: nocardiosis. New York J. Med. 63: 3422, 1963. MedlineGoogle Scholar67. GILLIGANWILLIAMSPERCEVAL BSIAK: Nocardial meningitis: report of a case with bacteriological studies. Med. J. Aust. 49: 747, 1962. CrossrefMedlineGoogle Scholar68. GOLDBERG SA: A case of systemic infection due to Nocardia asteroides. J. Einstein Med. Cent. 8: 148, 1960. Google Scholar69. GUTCH CF: Pneumonia caused by Nocardia asteroides. A case report. Nebraska Med. J 46: 47, 1961. MedlineGoogle Scholar70. GYDELLJUHLINLJUNGGRENNORDÉNFORS KIHJGB: Nocardiosis during steroid treatment of auto-immune haemolytic anaemia. Report of a fatal case. Acta Med. Scand. 178: 221, 1965. CrossrefMedlineGoogle Scholar71. HALL GV: A case of pulmonary nocardiosis with apparent cure with sulphadiazine. Med. J. Aust. 2: 455, 1964. CrossrefMedlineGoogle Scholar72. HORN WS: Miliary nocardiosis; fatal complication in Hodgkin's disease. Texas J. Med. 61: 328, 1965. MedlineGoogle Scholar73. IRVINGMARÉMIALE WRAJB: Unusual infections in lymphoma and leukemia. Southern Med. J. 58: 891, 1965. CrossrefGoogle Scholar74. JACOBSGIBSON SIRM: A fatal case of cerebral abscess due to Nocardia asteroides. J. Neurol. Neurosurg. Psychiat. 26: 363, 1963. CrossrefMedlineGoogle Scholar75. LANGEVINKATZ RWS: Fulminating pulmonary nocardiosis. Dis. Chest 46: 310, 1964. CrossrefMedlineGoogle Scholar76. LEEDORMANBRADHURST CDCPG: Disseminated nocardiosis: an acute fatal episode in a young girl. Med. J. Aust. 2: 536, 1963. CrossrefMedlineGoogle Scholar77. LUTZGROOTTENWITZ-BERGER AOMA: On 3 cases of "human nocardiosis." Strasbourg Med. 12: 720, 1961. Google Scholar78. MCANDREW GM: Cerebral nocardiosis. Postgrad. Med. J. 41: 639, 1965. CrossrefMedlineGoogle Scholar79. MURRAYHAEGELINHEWITTLATTAMCVICKARRASMUSSENRIGLER JFHFWLHDAFLG: Opportunistic pulmonary infections. Ann. Intern. Med. 65: 566, 1966. LinkGoogle Scholar80. PELLEGRINOHENDERSON EDRR: Response of pulmonary nocardiosis to treatment with massive doses of penicillin intravenously. Report of a successfully treated case with four-year follow-up observation, together with review of the literature. Amer. Rev. Resp. Dis. 84: 242, 1961. MedlineGoogle Scholar81. PIZZOLATOZISKINDDERMANBUFF PJHEE: Nocardiosis of the brain. Report of three cases. Amer. J. Clin. Path. 36: 151, 1961. CrossrefMedlineGoogle Scholar82. ROUGEMONTBATTESTIGOUTELLE JDMYA: [Abscess of the cerebellum caused by nocardia asteroides.] (Fr.) J. Med. Lyon 44: 605, 1963. MedlineGoogle Scholar83. SMITHBENECKE DEJ: Pulmonary nocardiosis: report of a fatal case. Med. J. Aust. 2: 254, 1960. CrossrefGoogle Scholar84. STEINESTRELLADOJUDD LREJM: Nocardiosis and tuberculosis. Report of a case of coexistent pulmonary tuberculosis and extrapulmonary nocardiosis. J. Thorac. Cardiov. Surg. 43: 314, 1962. CrossrefMedlineGoogle Scholar85. SUIEHAVENER TWH: Mycology of the eye: a review. Amer. J. Ophthal. 56: 63, 1963. CrossrefMedlineGoogle Scholar86. TALEGHANI-FARBARBERSAMPSONHARDEN MJBCKA: Cerebral nocardiosis and alveolar proteinosis. Amer. Rev. Resp. Dis. 89: 561, 1964. MedlineGoogle Scholar87. TARASZKIEWICZDWORAK SW: [Perirenal abscess caused by Nocardia asteroides.] (Pol.) Pol. Tyg. Lek. 20: 285, 1965. MedlineGoogle Scholar88. THIERSFAYOLLEMEUNIER HJP: [Mycotic osteitis of the sternum due to Nocardia asteroides with fever of an undulant nature.] (Fr.) Bull. Soc. Franc. Derm. Syph. 70: 931, 1963. MedlineGoogle Scholar89. THOMPSONWAX FRWV: Actinomycotic osteomyelitis in Paget's disease of the tibia treated with diasone and aureomycin. New York J. Med. 50: 1499, 1950. MedlineGoogle Scholar90. TOMMASILECUIREPLAUCHUGIRARDCOUDER MJMPFT: [Nocardia asteroides actinomycosis of the central nervous system.] (Fr.) Lyon Med. 92: 407, 1960. MedlineGoogle Scholar91. TVETEN L: Cerebral mycosis. A clinico-pathological report of four cases. Acta Neurol. Scand. 41: 19, 1965. CrossrefMedlineGoogle Scholar92. UTZ JP: The spectrum of opportunistic fungus infections. Lab. Invest. 11: 1018, 1962. MedlineGoogle Scholar93. VIRTANENLUNDELL SE: Nocardiosis. Report of a successful recovery. Ann. Chir. Gynaec. Fenn. 50: 472, 1961. MedlineGoogle Scholar94. WEBSTER BH: Bronchopulmonary nocardiosis. Amer. J. Med. Sci. 244: 40, 1962. CrossrefMedlineGoogle Scholar95. WILHITECOLE JLFH: Invasion of pulmonary cavities by Nocardia asteroides. Report of 5 cases. Amer. Surg. 32: 107, 1966. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GEORGE P. SUSENS, M.D.; ABDUL AL-SHAMMA, M.D.; JOHN C. ROWE, M.D.; CHARLES C. HERBERT, M.D.; MILTON L. BASSIS, M.D.; GRANVILLE C. COGGS, M.D.Affiliations: San Francisco, CaliforniaFrom the Department of Medicine, Kaiser Foundation Hospital, and the Departments of Surgery, Medicine, Pathology, and Radiology, The Permanente Medical Group, Kaiser Foundation Hospital, San Francisco, Calif.Requests for reprints should be addressed to George P. Susens, M.D., Kaiser Foundation Hospital, 2425 Geary Blvd., San Francisco, Calif. 94115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPéricardite constrictive et la nocardiose disséminéeNocardia asteroides Pericarditis in Association with HIVThe medically important aerobic actinomycetes: epidemiology and microbiologyNocardia species: host-parasite relationshipsCardiac Tamponade due to Nocardia asteroidesClinical Aspects of Atrial FibrillationConstrictive pericarditis from Nocardia asteroides infectionNocardia asteroides Pericarditis: Report of a Case and Review of the LiteraturePurulent pericarditisNocardia Asteroides aortitis with perforation of the aortaClinical, microbiologic and therapeutic aspects of purulent pericarditisAn Ultrastructural Analysis of Nocardia During Experimental Infections in MiceConstrictive Pericarditis Due to Infection with Nocardia AsteroidesNOCARDIA INFECTIONS IN A GENERAL HOSPITALNocardioseNocardiose 1 November 1967Volume 67, Issue 5Page: 1021-1032KeywordsBrainDiagnostic radiologyFungal diseasesHospital medicineLungsNocardiaResearch laboratoriesSteroid therapySurgery ePublished: 1 December 2008 Issue Published: 1 November 1967 PDF downloadLoading ...