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Obstructive pneumonia caused by Gordonia bronchialis with a bronchial foreign body

Open AccessPublished:September 20, 2022DOI:https://doi.org/10.1016/j.ijid.2022.09.028

      Highlights

      • Gordonia bronchialis is an emerging pathogen causing various infectious diseases.
      • This is the first report of pneumonia caused by G. bronchialis with a foreign body.
      • Conventional cultures cannot be used to identify G. Bronchialis accurately.
      • 16S ribosomal RNA gene sequencing provides definitive identification of Gordonia species.

      Keywords

      A 68-year-old man who was an ex-smoker with 35 pack-years presented with a 9-month history of cough. He was previously diagnosed with intraductal papillary neoplasm of the pancreas but did not have other diseases or conditions associated with immunosuppression. Chest computed tomography revealed infiltrations in the right lower lung (Figure 1a). Fiber-optic bronchoscopy revealed a bronchial foreign body with yellow sputum in the right lower lobe bronchus (Figure 1b), confirming obstructive pneumonia secondary to bronchial foreign body aspiration. The foreign body was a peanut fragment (Figure 1c). We performed 16S ribosomal (r)RNA gene sequencing after histopathological examination with Grocott staining revealed numerous hyphae (Figure 1d). Sputum culture analysis revealed gram-positive bacilli, suggesting an aerobic actinomycete, possibly Nocardia sp. Basic Local Alignment Search Tool analysis of 16S rRNA gene sequence showed 100.00% concordance with Gordonia bronchialis Diagnostic and Statistical Manual 43247 (accession number CP001802). No other organisms were previously isolated from the patient's sputum. His symptoms and radiological findings improved after foreign body removal without antibiotics.
      Figure 1
      Figure 1Radiological, bronchoscopic, and pathological findings of obstructive pneumonia with a bronchial foreign body. (a) Chest computed tomography revealed infiltrations in the right lower lung field. (b) Fiber-optic bronchoscopy imaging revealed a bronchial foreign body with yellow sputum in the right lower lobe bronchus. (c) The foreign body was a peanut fragment. (d) Grocott stain revealed numerous branching hyphae around the peanut.
      To the best of our knowledge, this is the first report of pneumonia caused by G. bronchialis. G. bronchialis causes infectious diseases attributed to foreign body insertions (e.g. coronary artery surgeries, insertion of pacemakers, intravascular catheters) (
      • Johnson JA
      • Onderdonk AB
      • Cosimi LA
      • Yawetz S
      • Lasker BA
      • Bolcen SJ
      • et al.
      Gordonia bronchialis bacteremia and pleural infection: case report and review of the literature.
      ) and needle injuries (
      • Choi ME
      • Jung CJ
      • Won CH
      • Chang SE
      • Lee MW
      • Choi JH
      • et al.
      Case report of cutaneous nodule caused by Gordonia bronchialis in an immunocompetent patient after receiving acupuncture.
      ). Most infections are intraoperatively transmitted from the environment. Herein, pneumonia developed from an obstruction with infiltrations, instead of the usual violation of soft tissue and isolation of bacterium. Diagnosis is difficult because conventional cultures cannot accurately identify G. bronchialis, which leads to its misdiagnosis as an actinomycete, such as Nocardia or Rhodococcus. Identification of Gordonia species is becoming more common with the incorporation of 16S rRNA gene sequencing (
      • Franczuk M
      • Klatt M
      • Filipczak D
      • Zabost A
      • Parniewski P
      • Kuthan R
      • et al.
      From NTM (Nontuberculous mycobacterium) to Gordonia bronchialis-a diagnostic challenge in the COPD patient.
      ). The present case draws the attention of clinicians to this emerging pathogen.

      Funding

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Ethical approval

      Written informed consent was obtained from the patient for publication of this case report and the accompanying images.

      Author contributions

      Directly provided patient care: H.N., S.H., S.M., K.M., A.M., and K.K. Microbiological and pathological analysis: K.U. and T.F. Drafted and edited manuscript and images: H.N., S.H., D.T., and M.T. Manuscript revision: all authors.

      Declaration of competing interest

      The authors have no competing interests to declare.

      References

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        • Jung CJ
        • Won CH
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        Case report of cutaneous nodule caused by Gordonia bronchialis in an immunocompetent patient after receiving acupuncture.
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        • Klatt M
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        From NTM (Nontuberculous mycobacterium) to Gordonia bronchialis-a diagnostic challenge in the COPD patient.
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        • Onderdonk AB
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        Gordonia bronchialis bacteremia and pleural infection: case report and review of the literature.
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