Abstract
Patients on immunosuppression are at risk of unusual infections. We present a man diagnosed to have adult-onset Still's disease who, on high-dose oral steroid and tacrolimus, developed a cavitating pneumonia due to co-infection with Aspergillus flavus and Nocardia. Timely diagnosis and institution of appropriate therapy resulted in a favourable clinical outcome. Such co-infection in a patient receiving tacrolimus is rare in the published literature. This case serves to emphasise the need to be vigilant for unusual infections in patients who are immunosuppressed, either due to drugs or underlying disease condition.
2014 BMJ Publishing Group Ltd.
MeSH terms
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Adult
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Anti-Bacterial Agents / therapeutic use
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Antifungal Agents / therapeutic use
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Aspergillosis / diagnosis*
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Aspergillosis / drug therapy
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Aspergillosis / immunology
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Coinfection / drug therapy*
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Coinfection / immunology
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Coinfection / microbiology
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Drug Therapy, Combination
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Follow-Up Studies
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Humans
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Immunocompromised Host
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / adverse effects*
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Male
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Nocardia Infections / diagnosis*
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Nocardia Infections / drug therapy
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Nocardia Infections / immunology
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Pneumonia / diagnostic imaging
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Pneumonia / drug therapy
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Pneumonia / microbiology*
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Radiography, Thoracic / methods
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Steroids / therapeutic use
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Still's Disease, Adult-Onset / diagnosis
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Still's Disease, Adult-Onset / drug therapy
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Still's Disease, Adult-Onset / immunology*
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Tacrolimus / therapeutic use
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Tomography, X-Ray Computed / methods
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Treatment Outcome
Substances
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Anti-Bacterial Agents
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Antifungal Agents
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Immunosuppressive Agents
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Steroids
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Tacrolimus