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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr1120092421.
Published online Sep 29, 2010. doi:  10.1136/bcr.11.2009.2421
PMCID: PMC3029947
Reminder of important clinical lesson
Nocardiosis in a patient with rheumatoid athritis treated with rituximab and a summary of reported cases
C S Ngiu,1 M S Mohamed Said,1 P Periyasamy,2 and S F Low3
1Department of Medicine, UKM, Kuala Lumpur, Malaysia
2Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia
3Department of Radiology, UKM Medical Center, Kuala Lumpur, Malaysia
Correspondence to C S Ngiu, csngiu/at/
Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.
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