{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:52:26Z","timestamp":1782283946298,"version":"3.54.5"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":173,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Infectious Diseases"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Anti\u2010granulocyte macrophage colony stimulating factor (anti\u2010GM\u2010CSF) antibodies, classically associated with pulmonary alveolar proteinosis (PAP), are increasingly recognised as a cause of adult\u2010onset immunodeficiency predisposing to opportunistic infections. Coinfections with multiple opportunistic pathogens in this context are uncommon. We describe a rare case of disseminated\n                    <jats:italic>Nocardia paucivorans<\/jats:italic>\n                    , pulmonary\n                    <jats:italic>Cryptococcus gattii,<\/jats:italic>\n                    pulmonary\n                    <jats:italic>Mycobacterium chelonae<\/jats:italic>\n                    , and subsequent PAP in a patient with high\u2010level anti\u2013GM\u2010CSF antibodies. A 64\u2010year\u2010old man presented with subacute bilateral shoulder pain and was diagnosed with acromioclavicular septic arthritis.\n                    <jats:italic>N. paucivorans<\/jats:italic>\n                    was isolated, and subsequent evaluation demonstrated disseminated infection with numerous brain abscesses, left eye endophthalmitis and pulmonary involvement. Interval computed tomography of the chest revealed new right lower lobe consolidation, a biopsy of which identified\n                    <jats:italic>C. gattii<\/jats:italic>\n                    and\n                    <jats:italic>M. chelonae<\/jats:italic>\n                    . Immunological testing confirmed high\u2010level anti\u2013GM\u2010CSF antibodies. The patient received prolonged combination antimicrobial therapy, including meropenem, ceftriaxone, linezolid, trimethoprim\u2010sulfamethoxazole, moxifloxacin, fluconazole, tigecycline and clofazimine, with clinical and radiological improvement of infectious lesions. Despite microbiological clearance, progressive bilateral ground\u2010glass opacities developed on serial chest imaging consistent with PAP, with no pathogens identified on bronchoscopic sampling. Given minimal respiratory symptoms, PAP\u2010directed therapy was deferred. The patient remains clinically stable on trimethoprim\u2010sulfamethoxazole prophylaxis with ongoing clinical and radiological surveillance. This case illustrates the expanding clinical spectrum of anti\u2013GM\u2010CSF antibody\u2010associated disease and underscores the importance of considering this diagnosis in patients presenting with opportunistic infections, in particular, disseminated nocardiosis or\n                    <jats:italic>C<\/jats:italic>\n                    .\n                    <jats:italic>gattii<\/jats:italic>\n                    infection. It also highlights the need for vigilance in evaluating for coinfections, recognition of PAP as a noninfectious codiagnosis, and the importance of long\u2010term follow\u2010up in affected patients.\n                  <\/jats:p>","DOI":"10.1155\/crdi\/5939262","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:42:45Z","timestamp":1782283365000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent\n                    <i>Nocardia<\/i>\n                    ,\n                    <i>Cryptococcus<\/i>\n                    and\n                    <i>Mycobacterium<\/i>\n                    Infections Unmask Anti\u2013GM\u2010CSF Antibody\u2013Associated Immunodeficiency and Pulmonary Alveolar Proteinosis: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3820-440X","authenticated-orcid":false,"given":"Vidthiya","family":"Menon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20211387"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.180.1.647"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-020-02141-7"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.752856"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.molimm.2012.04.009"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1202526"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/ipc.0000000000001313"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa241"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu968"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.859116"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2025.106588"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-022-02103-9"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2023-220040"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.2217\/bmm-2017-0362"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae269"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac146"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2024.12.094"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-024-01775-w"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/mbio.00912-14"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2024.01.018"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-024-01757-y"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13247"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-020-00796-5"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0066-3"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2012.03.020"},{"key":"e_1_2_12_26_2","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1183\/09031936.00197710","article-title":"An Open-Label Trial of Rituximab Therapy in Pulmonary Alveolar Proteinosis","volume":"38","author":"Kavuru M. 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