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Case Report

A complicated case of an immunocompetent patient with disseminated nocardiosis

by
Chad J. Cooper
*,
Sarmad Said
,
Maryna Popp
,
Haider Alkhateeb
,
Carlos Rodriguez
,
Mateo Porres Aguilar
and
Ogechika Alozie
Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
*
Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2014, 6(1), 5327; https://doi.org/10.4081/idr.2014.5327
Submission received: 28 January 2014 / Revised: 17 February 2014 / Accepted: 25 February 2014 / Published: 4 April 2014

Abstract

Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia wallacei species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying Nocardia infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.
Keywords: nocardia; lung abscess; brain abscess; septic emboli nocardia; lung abscess; brain abscess; septic emboli

Share and Cite

MDPI and ACS Style

Cooper, C.J.; Said, S.; Popp, M.; Alkhateeb, H.; Rodriguez, C.; Aguilar, M.P.; Alozie, O. A complicated case of an immunocompetent patient with disseminated nocardiosis. Infect. Dis. Rep. 2014, 6, 5327. https://doi.org/10.4081/idr.2014.5327

AMA Style

Cooper CJ, Said S, Popp M, Alkhateeb H, Rodriguez C, Aguilar MP, Alozie O. A complicated case of an immunocompetent patient with disseminated nocardiosis. Infectious Disease Reports. 2014; 6(1):5327. https://doi.org/10.4081/idr.2014.5327

Chicago/Turabian Style

Cooper, Chad J., Sarmad Said, Maryna Popp, Haider Alkhateeb, Carlos Rodriguez, Mateo Porres Aguilar, and Ogechika Alozie. 2014. "A complicated case of an immunocompetent patient with disseminated nocardiosis" Infectious Disease Reports 6, no. 1: 5327. https://doi.org/10.4081/idr.2014.5327

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