Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer

Abstract

Rationale: Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities.Patient concerns: A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests.Diagnoses: N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. Interventions:The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence.Outcomes: Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer.Lessons: Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.

Disseminated Nocardiosis with Pulmonary Fungus and Secondary Epilepsy: A Case Report

“…Disseminated nocardiosis is a rare, life-threatening disease that usually affects immunocompromised patients, and Nocardia farcinica is one of the most common causative pathogens. 2,[8][9][10][11] Its early diagnosis appears difficult and its overall prognosis remains unsatisfactory, partly owing to the variability of clinical manifestations and limitations of laboratory tests. [1][2]12 Meanwhile, co-infection with Nocardia farcinica and Aspergillus flavus in the lung is rare, severe and even fatal.…”

Clinical Characteristics of Nocardiosis: a Multicenter Retrospective Study in Korea

“…The incidence of nocardiosis seems to be increasing annually because of the increasing population of immunocompromised patients as well as increased awareness of the disease [ 7 ]. However, to the best of our knowledge, only one single-center study has been conducted in patients with nocardiosis in Korea; all other studies have been case reports [ 8 9 10 11 12 13 14 15 16 17 18 19 ]. Therefore, we aimed to investigate the clinical and laboratory characteristics of nocardiosis and the suitability of the current treatment approach in Korea.…”

Membranous Nephropathy Complicated with Disseminated Nocardia farcinica Infection: A Case Report and Literature Review

“…Currently, trimethoprim-sulfamethoxazole (TMP-SMX) is still regarded as the first-line drug for N. farcinica infection. Other antibiotics such as linezolid, 11 amikacin, 12 and imipenem 13 have also been reported to be effective in treatment combined with TMP-SMX. Conventional intensive antibiotic treatment has improved survival rates, but the overall prognosis of patients with disseminated N. farcinica infection remains unsatisfactory.…”