Rationale:Nocardia is a soil saprophyte,which can cause disseminated infection in immunocompromised patients.Early diagnosis and treatment can greatly improve prognosis.Patient concern:A 26-year-old male presented with repeated episodes of fever,cough and breathlessness for 3 months.Diagnosis:Mixed infection of Nocardia(N.)farcinica and N.cyriacigeorgica with diabetes and Cushing’s syndrome.Interventions:N.cyriacigeorgica was isolated from empyema fluid and N.farcinica from blood.Based on antimicrobial susceptibility,he was treated with imipenem,cotrimoxazole and amikacin.Outcome:Patient expired due to infection and delayed diagnosis.Lesson:Several cases of infection due to N.farcinica or N.cyriacigeorgica have been reported.But mixed infection caused by these two species is rare.Pulmonary and disseminated nocardiosis is associated with high mortality,especially in immunocompromised hosts.So early diagnosis and prompt treatment is needed.
Vrushali Harsh ThakarPrajakta JadhavAishwarya BabuMahadevan KumarAbhijeet Kantilal Mane
Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.
Yili XuHanyang QianWen QianLi DongWeiying LiuYan ZhuYaning MeiYi XuLing WangYi XiaXu QiHuanping MeiXueqiang XuHuijuan MaoChangying XingNingning Wang
