ArticleCureus2026
Delayed Microbiological Diagnosis and Fluoroquinolone-Associated Tendon Rupture in Pulmonary Nocardiosis Complicating Autoimmune Pulmonary Alveolar Proteinosis: A Case Report.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
This report describes pulmonary nocardiosis in autoimmune pulmonary alveolar proteinosis (PAP), characterized by delayed microbiological diagnosis and a severe fluoroquinolone-associated adverse reaction. The autoimmune form, mediated by anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies, predisposes patients to opportunistic infections due to impaired alveolar macrophage function. We describe a 48-year-old male smoker with a history of recurrent respiratory infections who presented with fever and hypoxemic respiratory failure. High-resolution CT demonstrated bilateral ground-glass opacities with superimposed interlobular septal thickening, consistent with a diffuse crazy-paving pattern predominantly involving the lower lobes, associated with focal consolidations in the left lower and right upper lobes. Despite initiation of broad-spectrum antimicrobial therapy, the patient exhibited clinical deterioration characterized by recurrence of fever, rising inflammatory markers (C-reactive protein (CRP) 298 mg/L), worsening hypoxemia with a decline in the PaO₂/FiO₂ ratio to 168, and radiological progression on repeat high-resolution computed tomography (HRCT), demonstrating increased areas of consolidation and expansion of ground-glass opacities. A milky-appearing bronchoalveolar lavage (BAL) initially yielded negative cultures; however, after 14 days of incubation, it revealed growth of
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