Dual disseminated infection with Nocardia farcinica and Mucor in a patient with systemic lupus erythematosus: a case report

Abstract

IntroductionInfections remain a major cause of morbidity and mortality in immunocompromised patients and require early diagnosis and treatment. However, correct diagnosis and treatment are often delayed by a multitude of factors. We report what we believe to be the first case of a combined disseminated infection with Nocardia and Mucor in a patient with systemic lupus erythematosus.Case presentationA 74-year-old Caucasian woman with systemic lupus erythematosus presented with recurrent pneumonia. Despite empirical treatment with antibiotics, her condition gradually deteriorated. Microbiological sampling by thoracoscopy revealed the presence of Nocardia. Despite the institution of therapy for disseminated nocardiosis, she died of multi-organ failure. A post-mortem investigation confirmed nocardiosis, but showed concomitant disseminated mucormycosis infection as well.ConclusionMembers of the bacterial genus Nocardia and the fungal genus Mucor are ubiquitous in the environment, have the ability to spread to virtually any organ, and are remarkably resistant to appropriate therapy. Both pathogens can mimic other pathologies both on clinical and radiological investigations. Invasive sampling procedures are often needed to prove their presence. Establishing a timely, correct diagnosis and a specific treatment is essential for patient survival.

Disseminated nocardiosis in an immunosuppressed patient with systemic lupus erythematosus and neuromyelitis optica spectrum disorder

“…Pulmonary nocardiosis has a propensity to respond partially to empiric antimicrobial treatment which can lead to a fatal delay in diagnosis, as seen in a case report of a patient who had multiple hospitalizations for presumed pneumonia, responded to treatment each time, however eventually succumbed to nocardia with concomitant mucormycosis after being treated with high dose steroids and azathioprine for an SLE flare. 2…”

“…1 It remains challenging to diagnose as symptoms of pulmonary nocardiosis can initially respond to empiric antibiotic treatment for pneumonia however the disease can then re-present with disastrous consequences. 2 The antibiotic regimen is different for nocardia infections than for common pulmonary infections and treatment needs to be long-term. 3 As such, nocardiosis needs to be considered as part of the differential diagnosis when evaluating a patient who is immunosuppressed and appears to have an infection, and attention must be given to any extrapulmonary symptoms which can point to multiorgan involvement.…”

Pulmonary mucormycosis in systemic lupus erythematosus: successful management of a case along with review of literature

“…Table 1 summarizes disseminated and pulmonary mucormycosis cases reported in literature [8][9][10][11][12][13][14][15].…”