case_images: PMC11702207_01
case_images: PMC11702207_02
case_images: High-resolution chest computed tomography scan. (A) Subpleural bulla measuring 5 x 2.5 cm in the apical segment of the left lower lobe. (B) Diffuse hypodensity of the lung parenchyma, with hypodense wall images predominantly in the lower lobes
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case_images: PMC11702207_02_12879_2024_10413_Fig1_HTML.jpg
case_images: Fig1
case_images: A chest computed tomography scan revealed a subpleural bulla in the apical segment of the left lower lobe (Fig. 1A), diffuse hypodensity of the lung parenchyma, hypodense wall images predominantly in the lower lobes, along with pleural thickening of nodular appearance in the right lung. Confluent lymphadenopathies were also observed in the left pre-vascular chain, without any signs of cavitation or a tree-in-bud pattern (Fig. 1B).
case_images: PMC11702207_03
case_images: Phenotypic identification of N. farcinica. (A) Growth of slightly rough, dry, beige/brown colonies on Sabouraud agar. (B) Gram and Ziehl-Neelsen staining: microsiphoned gram-positive filaments, partially acid-fast. (C) Urea agar: positive. (D) Amino acids: casein: positive, tyrosine: negative, xanthine: negative
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case_images: PMC11702207_03_12879_2024_10413_Fig2_HTML.jpg
case_images: Fig2
case_images: After seven days of incubation at 25  C, slightly rough, dry, beige-to-brown colonies were observed on Sabouraud agar (Fig. 2A). The colonies underwent Ziehl-Neelsen and Gram staining, revealing partially acid-fast and Gram-positive microsiphonated filaments (Fig. 2B). A urease test yielded positive results (Fig. 2C), providing presumptive identification of Nocardia spp. Based on these conventional tests, the isolated organism was identified as N. farcinica (Fig. 2D).
case_images: Histological study of bone marrow. (A) Presence of nodular aggregates with paratrabecular and interstitial localization, hematoxylin and eosin: 40X. (B) Medium to large cells with paratrabecular localization, hematoxylin and eosin: 400X. (C) Neoplastic cells expressing CD20 on the cytoplasmic membrane, 400X
case_images: 12879_2024_10413_Fig3_HTML.jpg
case_images: PMC11702207_03_12879_2024_10413_Fig3_HTML.jpg
case_images: Fig3
case_images: Immunohistochemical analysis confirmed a diagnosis of large cell non-Hodgkin's lymphoma of B-cell lineage (Fig. 3).