A Novel Case of Pulmonary Nocardiosis with Secondary Hemophagocytic Lymphohistiocytosis

A 48‐year‐old Chinese male presented with skin rash, high‐grade fevers, and arthralgia. He was diagnosed as adult‐onset Still’s disease and treated with corticosteroids. The patient’s symptoms improved with no fever, and the leukocyte count and other inflammatory markers returned to normal after six weeks of treatment. However, two months later, his body temperature elevated again and he developed cough and yellow sputum. Chest computed tomography (CT) scan showed nodules with cavitation in the left lower lobe and bilateral multifocal ground‐glass opacities [Figure 1a]. He was given imipenem and cilastatin sodium, vancomycin, and caspofungin with reduced dose of corticosteroid. Unfortunately, his symptoms and abnormalities on CT scan tended to get worse [Figure 1b]. Lung biopsy was performed with no diagnostic findings.