Pulmonary nocardiosis concurrent with Pneumocystic carinii pneumonia in a case of smoldering adult T-cell leukemia

A 76-year-old man, with concomitant pulmonary nocardiosis and Pneumocystis carinii (PC) pneumonia, is described. He suffered from smoldering type adult T-cell leukemia and strongyloidiasis. Chest X-rays showed bilateral infiltrative shadows. Nocardia asteroides was isolated from sputum and bronchofiberoscopic aspirates. PC was not detected, however, despite the chest X-ray raising the suspicion of PC pneumonia. Since PC antigen was detected by immunoelectrophoresis in the absence of other clinical or histologic data, we diagnosed a latent PC infection. He improved with the use of cefuzonam and ST compounds, but experienced recurrence five months after discharge. N. asteroides and PC were detected from sputum on the second admission. As multiple concurrent infections with opportunistic organisms are not uncommon in immunocompromised hosts, we must maintain a high index of suspicion for opportunistic infection in cases such as this one.