DOI: 10.12890/2025_005756

The balance between autoimmunity and infection: a case report of concomitant pathology of pulmonary nocardia and granulomatosis with polyangiitis at initial presentation

Authors

  • Abdulrahman Abdullah Alhumaidi Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
  • Eid Mohammed Aljohani Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
  • Wajd Ahmed Althakafi Histopathology Unit, Department of Pathology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
  • Ohud Mohammed Alkinani Medical Subspecialities Department, Adult Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia
  • Faisal Abdullah Albalawi Medical Subspecialities Department, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia

alhumaidi591a@gmail.com

Keywords

Granulomatosis with polyangiitis, pulmonary nocardia, immunosuppressive therapy, dual pathology, trimethoprim/sulfamethoxazole

Abstract

Concurrent presentation of pulmonary nocardiosis and granulomatosis with polyangiitis (GPA) is exceptionally rare and diagnostically challenging, given the overlapping clinical and radiological features. We report a 54-year-old female with fever, cough, weight loss, and arthralgia. Chest imaging showed multiple pulmonary nodules; serology revealed positive anti-neutrophil cytoplasmic antibodies -proteinase 3, and lung biopsy demonstrated necrotizing granulomatous inflammation with Nocardia species. This led to a dual diagnosis of pulmonary nocardiosis and limited form GPA. The patient improved with co-trimoxazole however methotrexate is set to be initiated concomitantly with close monitoring as the manifestations of limited form GPA were still present. This case highlights the importance of considering infectious mimics during initial evaluation of suspected vasculitis, the possibility of dual pathology of both entities, and the emphasis of the staged approach of treating such cases in the background of controlling infection followed by initiating immunosuppressive therapy.

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References

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Published

2025-08-22

Issue

Vol. 12 No. 9 (2025)

Categories

How to Cite

1.
Alhumaidi AA, Aljohani EM, Althakafi WA, Alkinani OM, Albalawi FA. The balance between autoimmunity and infection: a case report of concomitant pathology of pulmonary nocardia and granulomatosis with polyangiitis at initial presentation. EJCRIM [Internet]. 2025 Aug. 22 [cited 2026 Nov. 3];12(9). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5756