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Subacute pnumonia --> lung abcess
Prepared by...Virat Sirisanthana, M.D.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University

Chief Complaint : Prolonged fever and cough

History of Present Illness
A 6 year-old boy had a 2-month-history of  fever and cough. He was diagnosed as HIV-infected (Category C)  boy due to this chronic illness. His serial  chest radiographs are shown below:
CXR1-nocardia-before-Rx.jpg (37756 bytes) CXR3-nocardia-before-Rx.jpg (35313 bytes)

Early

Before lung aspiration

Needle aspiration was done under ultrasound (with the curtesy of  Dr. Chusuk Sirivanish., Radiology department): The specimen was smear and stained. Below:

norca-gram-pus-2-sm-arrow.jpg (6491 bytes)

AF-branching-nocardia-2.jpg (40449 bytes)

Gram stain 1000X

modified AFB stain 1000X

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