Disseminated Nocardiosis Masquerading as Soft-Tissue Malignancy

Abstract

Case: A 59-year-old man, immunosuppressed after renal transplant, presented with a painful posterior thigh mass concerning for malignancy, as well as pulmonary and posterior chest wall nodules. Cultures and mass spectrometry identified Nocardia paucivorans. The patient underwent operative irrigation and debridement of the posterior thigh and chest wall, with 12 months of antibiotic therapy. Conclusion: A 2-week delay in appropriate treatment was due to low suspicion for infectious etiology. Since cultures generally take weeks for positive diagnosis, advanced molecular or biochemical methods should be used. This case demonstrates importance in maintaining a high index of suspicion for nocardiosis in immunocompromised patients with soft-tissue masses.

Disseminated Nocardia paucivorans Infection Resembling Metastatic Disease in a Kidney Transplant Recipient

“…When the central nervous system (CNS) is involved, patients may also experience headaches, confusion, and seizure [ 10 ]. Once disseminated, nocardiosis can resemble findings of metastatic malignancy [ 6 , 15 ]. One such report by Wuthrich et al involved N. paucivorans infection in a renal transplant recipient, similar to our case [ 6 ].…”

“…Once disseminated, nocardiosis can resemble findings of metastatic malignancy [ 6 , 15 ]. One such report by Wuthrich et al involved N. paucivorans infection in a renal transplant recipient, similar to our case [ 6 ]. The authors reported that a 59-year-old male with a history of renal transplant for kidney disease due to vasculitis presented with a painful thigh mass.…”

“…The authors reported that a 59-year-old male with a history of renal transplant for kidney disease due to vasculitis presented with a painful thigh mass. He was subsequently found to have multiple pulmonary and chest wall lesions on imaging, and biopsy showed no evidence of malignancy, but culture grew N. paucivorans [ 6 ].…”

“…The consequences of these infections may be devastating without prompt diagnosis and intervention [ 5 ]. Disseminated nocardiosis resembling metastatic disease in lung and kidney transplant recipients has rarely been reported in the literature [ 3 , 6 ]. In this article, we present a case of disseminated Nocardia paucivorans infection that resembled metastatic disease in an immunocompromised kidney transplant recipient.…”