Pediatric Infectious Disease

Register      Login

VOLUME 3 , ISSUE 3 ( July-September, 2021 ) > List of Articles


Invasive Pulmonary Aspergillosis and Nocardiosis in a Child with Possible Hyperimmunoglobulin E Syndrome

Savita G Krishnamurthy, Chikkanayakanahalli Indumathi, Kanchamaranahalli L Madhura, Raghavendra Kulkarni

Keywords : Hyperimmunoglobulin E syndrome, Invasive aspergillosis, Nocardia, Primary Immunodeficiency, Tuberculosis

Citation Information : Krishnamurthy SG, Indumathi C, Madhura KL, Kulkarni R. Invasive Pulmonary Aspergillosis and Nocardiosis in a Child with Possible Hyperimmunoglobulin E Syndrome. Pediatr Inf Dis 2021; 3 (3):113-115.

DOI: 10.5005/jp-journals-10081-1288

License: CC BY-NC 4.0

Published Online: 25-01-2022

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim and objective: To highlight the importance of looking for rare opportunistic as well as coinfections in children with primary immunodeficiency. Background: Opportunistic infections are often seen in children with primary immunodeficiency. Infections like nocardiosis and aspergillosis often mimic tuberculosis. So far, a single case of nocardiosis in hyperimmunoglobulin E syndrome (HIES) has been reported but none with coinfection with aspergillosis. Here we report a child with possible HIES presenting with nocardiosis and invasive pulmonary aspergillosis. Case description: A 3-year-old boy with recurrent abscesses and pneumonia presented to us with persistent fever and cough for 5 months, unresponsive to antitubercular therapy. Considering the suggestive history, characteristic facies, and elevated immunoglobulin E levels, HIES was diagnosed based on the NIH (National Institute of Health)-HIES score. High-resolution CT chest revealed mediastinal lymphadenopathy with right-sided nodular infiltrates and bilateral bronchiectasis. A positive serum galactomannan assay and growth of Aspergillus in bronchoalveolar lavage confirmed invasive aspergillosis. Mediastinal lymph node aspirate showed acid fast bacilli on smear and culture grew Nocardia species. Conclusion: It is important to look for rare opportunistic as well as coinfections in children with primary immunodeficiency. To the best of our knowledge, ours is the first report of pulmonary aspergillosis and nocardiosis in a child with HIES. Clinical significance: Albeit much rarer, aspergillosis and pulmonary nocardiosis can be close mimics of tuberculosis. Nonresolving pulmonary symptoms in the immunocompromised host must raise a suspicion of opportunistic infections including nocardiosis as early diagnosis and treatment may alter outcomes.

PDF Share
  1. Lee WS, Boey CC, Goh AY. Pulmonary nocardiosis in a child with hyperimmunoglobulin E syndrome. Singapore Med J 1999;40:280.
  2. Grimbacher, et al. Diagnosing the hyper IgE syndrome: incidence of clinical features. Inmunologia 2002;21:2–4.
  3. Woellner C, Gertz EM, Schäffer AA. Mutations in STAT3 and diagnostic guidelines for hyper-IgE syndrome. J Allergy Clin Immunol 2010;125(2):424–432. DOI: 10.1016/j.jaci.2009.10.059.
  4. Schimke LF, Sawalle-belohradsky J, Roesler J, et al. Diagnostic approach to the hyper-IgE syndromes: immunologic and clinical key findings to differentiate hyper-IgE syndromes from atopic dermatitis. J Allergy Clin Immunol 2010;126(3):611-7.e1. DOI: 10.1016/j.jaci.2010.06.029.
  5. Singh A, Mandal A, Seth R. Hyper IgE syndrome: often a missed diagnosis. Int J Contemp Pediatr 2016;3:674–677. DOI: 10.18203/2349-3291.ijcp20161064.
  6. Patel NH, Padhiyar JK, Shah YB, et al. Unusual presentations and associations of hyper IgE syndrome: retrospective analysis of ten cases at tertiary care institute – with review of indian published reports. Indian J Paediatr Dermatol 2018;19(1):31–36. DOI: 10.4103/ijpd.IJPD_144_16.
  7. Vinh DC, Sugui JA, Hsu AP, et al. Invasive fungal disease in autosomal-dominant hyper-IgE syndrome. J Allergy Clin Immunol 2010;125(6):1389–1390. DOI: 10.1016/j.jaci.2010.01.047.
  8. Fan H, Huang L, Yang D, et al. Pediatric hyperimmunoglobulin E syndrome: a case series of 4 children in China. Medicine (Baltimore) 2018;97(14):e0215. DOI: 10.1097/MD.0000000000010215.
  9. Ambrosioni J, Lew D, Garbino J. Nocardiosis: update clinical review and experience at a tertiary center. Infection 2010;38(2):89–97. DOI: 10.1007/s15010-009-9193-9.
  10. Minero MV, Marín M, Cercenado E, et al. Nocardiosis at the turn of the century. Medicine 2009;88(4):250–261. DOI: 10.1097/MD.0b013e3181afa1c8.
  11. Hamadani M, Benson Jr DM, Blum W, et al. Nocardia and aspergillus co-infection in a patient with chronic graft-versus-host disease. Transpl Infect Dis 2008;10(1):24–26. DOI: 10.1111/j.1399-3062.2007.00268.x.
  12. Uppal G, Potula R, Truant AL. Nocardia and aspergillus pulmonary infection in a patient on long-term steroid treatment: case report and literature review. Clin Microbiol Newslett 2015;37(5):35–39. DOI: 10.1016/j.clinmicnews.2015.02.001.
  13. Meena DS, Kumar D, Bohra GK, et al. Pulmonary nocardiosis with aspergillosis in a patient with COPD: a rare co-infection. IDCases 2020;20:e00766. DOI: 10.1016/j.idcr.2020.e00766.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.