Disseminated nocardiosis diagnosed by fine needle aspiration biopsy: Quick and accurate diagnostic approach

Abstract

Nocardia is an uncommon pathogen in immunocompetent patients; however, it has been increasingly recognized as a significant opportunistic pathogen in organ transplant patients. Diagnosis of Nocardiosis is usually made by microbiologic culture or cytologic examination of pulmonary specimens including, sputum, and brushing/washings or by histologic evaluation of tissue biopsy material. We report a case of subcutaneous Nocardiosis diagnosed by Fine-needle aspiration biopsy (FNA). The patient is a 66-year-old man with a history of lung transplantation and posttransplant lymphoproliferative disorder who presented with subcutaneous masses in the right upper arm and the left shoulder. FNA was performed in an outpatient clinic setting, with immediate morphologic assessment revealing filamentous branching organisms suspicious for Nocardiosis. Subsequent examination with special stains and microbiologic culture confirmed the diagnosis. The quick and accurate diagnosis by FNA led to emergent and appropriate treatment.

Isolated abdominal nocardiosis in a pediatric renal transplant recipient

“…17 Among RT recipients, besides usual immunosuppressive agents, plasmapheresis may be one of the risk factors, with lungs and brain being the two most common sites of infection. 6,[20][21][22][23] However, skin 24,25 and ocular infections 11 can also occur. Also, nocardia may coexistent with other opportunistic infections such as aspergillus and CMV.…”

Disseminated subcutaneous nocardiosis caused by Nocardia farcinica diagnosed by FNA biopsy and 16S ribosomal gene sequencing

“…Primary cutaneous infection is most often the result of direct inoculation of the bacteria due to trauma or surgery. 2,3,17 Nocardia farcinica is a recently described and distinct species, formerly known as N. asteroides type V drug susceptibility pattern. 1,5 This species retained its status after the publication of the Judicial Commission of the International Committee on Systemic Bacteriology in 1989 using type strain ATCC3318.…”

“…6,10,12,15,17 However, we know of only three cases of subcutaneous nocardiosis reportedly diagnosed by aspiration cytology. 6,15,17 The aspirate smears typically show severe acute inflammation in the form of suppurative abscesses and necrosis. Gram stain reveals slender, filamentous Gram positive bacilli, often with notable branching, which measure 0.5-1 lm in diameter and as much as 20 lm in length.…”