广州中医药大学第一附属医院于2021年11月3日收治1例67岁男性“咳嗽，右肺占位性病变”患者，患者自诉反复咳嗽咳痰50余年，半月前症状加重，在外院行胸部CT检查提示肺部占位病变，有猫、犬接触史，曾因皮肤瘙痒、皮疹呈线状在外院治疗。入院后痰、粪镜检可见活动的粪类圆线虫，胸部CT平扫 + 增强结果提示，右肺下叶背段肺癌（25 mm × 24 mm），双肺上叶、下叶小结节，未排除转移；支气管镜检查结果示，右主支气管通畅，上叶、下叶支气管及各段、亚段支气管通畅，黏膜充血，可见少量白色分泌物，未见新生物。肺泡灌洗液二代测序，检测到粪类圆线虫序列290条、豚鼠耳炎诺卡菌序列102条；肺泡灌洗液培养，见豚鼠耳炎诺卡菌阳性。诊断为“肺粪类圆线虫合并肺诺卡菌感染”，予复方磺胺甲恶唑片（0.96 g/次，1次/6 h，连服3个月）、注射用头孢哌酮钠舒巴坦钠（3 g/次，1次/12 h，注射14 d）、阿苯达唑片治疗（400 mg/次，2次/d，连服7 d为1个疗程，间隔1个月后继续1个疗程）。治疗1周后复查痰及粪检，提示线虫多数死亡，少量存活。2个月后复诊，复查胸部CT提示病灶明显缩小。

On November 3, 2021, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine admitted a 67-year-old male patient with “cough and space-occupying lesions in the right lung”. The patient complained of repeated cough and expectoration for more than 50 years. The symptoms worsened half a month ago. Chest CT in the external hospital showed space-occupying lesions in the lung. He had a history of contact with cats and dogs. He had been treated elsewhere for skin pruritus and rash. After admission, active Strongyloides stercoralis was found in sputum and feces by microscopic examination. Chest enhanced CT suggest lung cancer in the dorsal segment of the lower lobe of the right lung (25 mm × 24 mm), small nodules in the upper and lower lobes of both lungs and possible metastasis cannot be excluded; the bronchoscopy showed that the right main bronchus was unobstructed, the upper lobe and lower lobe bronchus, as well as each segment and sub-segment bronchus, were unobstructed, the mucosa was congested, a small amount of white discharge was seen, and no neoplasm was found. S. stercoralis (290 sequences) and Nocardia otitidiscaviarum (102 sequences) were detected in alveolar lavage fluid next-generation sequencing. Nocardia was found in the alveolar lavage fluid culture. It was diagnosed as “pulmonary S. stercoralis complicated with N. otitidiscaviarum infection”. The patient was treated with a combination of sulfamethoxazole (0.96 g once, once per 6 h for 3 months), cefoperazone sodium and sulbactam sodium (3 g once, once per 12 h for 14 days), albendazole (400 mg twice daily for 7 days, continue 1 course after 1 month). After one week, sputum and fecal microscopic examination showed that most of the S. stercoralis died with a small amount survived. After 2 months follow-up, chest CT showed that the lesions were significantly reduced.