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Reminder of important clinical lesson
Nocardiosis in a patient with rheumatoid athritis treated with rituximab and a summary of reported cases
  1. C S Ngiu1,
  2. M S Mohamed Said1,
  3. P Periyasamy2,
  4. S F Low3
  1. 1Department of Medicine, UKM, Kuala Lumpur, Malaysia
  2. 2Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia
  3. 3Department of Radiology, UKM Medical Center, Kuala Lumpur, Malaysia
  1. 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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  • Competing interests None.

  • Patient consent Obtained.

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