Disseminated nocardiosis during systemic steroid therapy for the prevention of esophageal stricture after endoscopic submucosal dissection.

Abstract

An 85-year-old man underwent endoscopic submucosal dissection for a large superficial esophageal epithelial neoplasm, which required removal of 95% of the circumference of the esophageal mucosa. Steroids were given orally to prevent esophageal stricture starting on day 3 postoperatively. In the 6th week of steroid treatment, he developed high fever without other symptoms. Chest computed tomography revealed a nodular lesion in the lung. Sputum sample showed Gram-positive, branching, filamentous bacteria, and a diagnosis of nocardiosis was suspected. Brain magnetic resonance imaging revealed multiple focal lesions which indicated dissemination of nocardiosis. Trimethoprim-sulfamethoxazole was immediately started, which led to the disappearance of pulmonary and cerebral nocardiosis with alleviation of fever. Recently, oral steroid treatment has been widely used for the prevention of esophageal stricture. However, the present case indicates the risk of life-threatening infection and the importance of close monitoring of this treatment.

• Authors: Tsukasa Ishida, Yoshinori Morita, Namiko Hoshi, Tetsuya Yoshizaki, Yoshiko Ohara, Fumiaki Kawara, Sinwa Tanaka, Yuki Yamamoto, Hiroo Matsuo, Kentaro Iwata, Takashi Toyonaga, Takeshi Azuma
• Journal: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (Dig Endosc) Vol. 27 Issue 3 Pg. 388-91 (Mar 2015) ISSN: 1443-1661 [Electronic] Australia
• PMID: 24889691 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Chemical References

• Prednisolone

Topics

• Administration, Oral
• Aged, 80 and over
• Bacteremia (chemically induced, physiopathology)
• Dissection (methods)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Esophageal Neoplasms (pathology, surgery)
• Esophageal Stenosis (prevention & control)
• Esophagoscopy (adverse effects, methods)
• Follow-Up Studies
• Humans
• Male
• Mucous Membrane (pathology, surgery)
• Nocardia Infections (chemically induced, physiopathology)
• Prednisolone (administration & dosage, adverse effects)
• Risk Assessment