A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Abstract

Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. Only 5 cases have been reported in the United States. We present a case of disseminated Nocardia beijingensis involving the lung, subcutaneous tissue, and central nervous system of an immunocompetent patient.Clinical Findings: A 60-year-old immunocompetent male with no significant medical history presented to our hospital after a complicated medical course, beginning with vague respiratory complaints. His initial work-up revealed a large mass of unclear etiology in the right upper lung. A month later, he had a syncopal episode and then developed focal neurologic deficits.Sputum cultures obtained after the patient's syncopal episode grew gram-positive rods. Results of a computed tomography of the chest showed a new 17-mm subcutaneous mass. The mass was biopsied, which revealed gram-positive rods with partial acid-fast staining. Week later, results of magnetic resonance imaging of his brain showed multiple enhancing lesions with vasogenic edema scattered throughout. A tissue culture from his chest mass was sent to the Mayo Clinic and ultimately grew Nocardia beijingensis. The patient was started on the appropriate antibiotic therapy and has made significant clinical improvement. Conclusions:Though Nocardia is often associated with an immunocompromised state, it can also occur in patients with pulmonary findings and evidence of disseminated disease, particularly central nervous system manifestations, regardless of immune status. A high index of suspicion is needed, as definitive diagnosis often takes weeks due to the slow-growing nature of Nocardia species.

Stroke like presentation of disseminated CNS Nocardia beijingensis infection in an immunocompetent patient: Case report and review of the literature

“…This was followed by additional reports of pulmonary Nocardiosis [ [15] , [16] , [17] , [18] ] and one case of scleritis in immunocompetent hosts [ 19 ]. The first case reports of CNS involvement in immunocompetent patients were reported in 2019 and again in 2020 [ [20] , [21] , [22] , [23] , [24] ]. Table 2 summarizes reported cases of N. beijingensis in immunocompetent patients.…”

“…At 9 months, CT showed near resolution of lung mass [ 18 ] 2020 Japan 68 year old male with military cerebrospinal lesions and right middle lobe atelectasis Lung, brain, brain stem, spinal cord TMP-SMX + meropenem, followed by SMX-TMP for 7 months Mild confusion and irritability, discharged to another facility for long term care [ 22 ] 2020 Maine 60 year old male with primary pulmonary disease and dissemination to subcutaneous tissue and CNS Pulmonary, subcutaneous, and CNS IV TMP-SMX + meropenem for 6 weeks transitioned to TMP-SMX for 12 months 2 months after diagnosis, CT show near resolution of lung mass. 5 months later, Brain MRI show decrease in lesion size [ 23 ] 2020 Illinois 57 year old female presented following seizure-like activity. Imaging revealed pulmonary and CNS abscesses Pulmonary and CNS IV TMP-SMX for 6 weeks followed by oral TMP-SMX for 12 months Chest CT at 1 year show near resolution of lung mass, Brain MRI at 6 months showed resolution of vasogenic edema [ 24 ] 2021 Florida Our Patient.…”