Nocardia farcinica Brain Abscess in an Immunocompetent Host With Pulmonary Alveolar Proteinosis: A Case Report and Review of the Literature

Grond, Sarah E.; Schaller, Alyssa; Kalinowski, Alexandra; Tyler, Kimberly A.; Jha, Pinky

doi:10.7759/cureus.11494

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…In the diagnosis and treatment of Nocardia, the spread of Nocardia affects at least two adjacent organs, especially brain abscess, which is an important factor in the adverse outcome of patients. We searched relevant literature from 2017 to 2021 in PubMed and Web of Science using disseminated Nocardia infection and case reports as the keywords and included confirmed disseminated Nocardia infection involving 2 organs and the above, complete records of adult cases, a total of 126 cases of disseminated Nocardia infection were retrieved, a total of 23 cases were included in the study (13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), and the remaining 113 cases (58 cases involving less than 2 organs, 23 cases with disease course records incomplete, 12 cases with other infections, 11 cases with no confirmed Nocardia infection, 4 cases where the full text could not be found, and 5 cases reported non-human or adult cases) were excluded. A summary and review of the 23 cases are presented below (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review

Wei

Bao²,

Wang³

et al. 2022

Front. Med.

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Nocardia disease is a rare opportunistic infection that usually occurs in individuals with solid organ transplantation, malignant tumors, human immunodeficiency virus (HIV) infection, or chronic lung disease history. Here, we reported a rare case of cryptogenic organizing pneumonia (COP) combined with disseminated Nocardia infection. A 75-year-old man was admitted to the respiratory department due to weakness and poor appetite for 3 months. The chest CT scan showed dense patchy shadows in the dorsal lower lobe of both lungs. After the transbronchial lung biopsy, the histopathological findings supported the diagnosis of COP. During the period of glucocorticoid reduction (oral methylprednisolone tablets 24 mg one time a day), the patient presented with masses on the back and bilateral upper limbs and intermittent fever for 3 days. After admission, the patient underwent a series of examinations and an ultrasound puncture of the mass. The puncture fluid was caseous necrosis, which was confirmed to be Nocardia infection after bacterial culture, so the diagnosis was disseminated Nocardia infection. After 13 days of admission, the patient developed a headache, accompanied by decreased visual acuity and blurred vision. An imaging (enhanced brain CT) examination revealed intracranial space-occupying lesions. The neurosurgeon was consulted and performed transcranial abscess puncture and drainage, intravenous antibiotics (meropenem, etc.) for 2 months, and trimethoprim/sulfamethoxazole (TMP-SMX) for 6 months. The patient was followed up for 3 years and has remained relapse-free. The mortality rate of disseminated Nocardia infection is as high as 85%, especially when combined with brain abscesses. Therefore, timely diagnosis and correct treatment are crucial for the prevention of fatal consequences. The report of this case can enable more patients to receive early diagnosis and effective treatment, so as to obtain a satisfied prognosis.

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Section: Discussionmentioning

confidence: 99%

Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review

Wei

Bao²,

Wang³

et al. 2022

Front. Med.

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“…Nocardia brain abscess is rare and typically found in immunocompromised patients [ 1 ]. Nocardia infections comprise only 2% of all intracranial abscesses [ 2 ], but overall mortality rate can exceed 20% [ 3 , 4 ]. Brain abscess caused by Nocardia farcinica is rarely reported in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A case report of brain abscess caused by Nocardia farcinica

et al. 2021

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Background Brain abscess due to the Nocardia genus is rarely reported and it is usually found in immunocompromised patients. Treatment of Nocardia brain abscess is troublesome and requires consideration of the severity of the underlying systemic disease. The difficulties in identifying the bacterium and the frequent delay in initiating adequate therapy often influence the prognosis of patients. Case presentation Here, we report a rare case of brain abscess caused by Nocardia farcinica. The patient’s medical history was complicated: he was hospitalized several times, but no pathogens were found. At last, bacteria were found in the culture of brain abscess puncture fluid; the colony was identified as Nocardia farcinica by mass spectrometry. Targeted antibiotic treatment was implemented, brain abscess tended to alleviate, but the patient eventually developed fungal pneumonia and died of acute respiratory distress syndrome (ARDS). Conclusion Brain abscess caused by Nocardia farcinica can appear in non-immunocompromised individuals. Early diagnosis, reasonable surgical intervention, and targeted antibiotic treatment are critical for Nocardia brain abscess treatment. In the treatment of Nocardia brain abscess, attention should paid be to the changes in patients’ immunity and infection with other pathogens, especially fungi, avoided.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Pan¹,

Wang²,

Meng³

et al. 2021

IDR

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Disseminated infection caused by Nocardia farcinica with primary nephrotic syndrome is exceedingly rare. A 66-year-old female visited the outpatient department due to fever and fatigue who had been diagnosed as membranous nephropathy and with a longterm prednisone and immunosuppressive therapy. After lung biopsy for many times, culture from space-occupying lesion of the right lung and species identification by mass spectrometry-based methods (MALDI-TOF) revealed Nocardia farcinica. By imaging examination, space-occupying lesions from the lungs, brain, abdominal cavity and kidney were found. After 2 weeks of meropenem intravenous and up to 6 months of trimethoprimsulfamethoxazole (TMP-SMX) therapy, our patient has remained relapse-free at that time of writing. Disseminated infection caused by Nocardia farcinica is usually subacute with complex clinical manifestations. In addition, it can be easily confused with diseases such as tumor and mycobacterial infection, and lead to fatal consequences. Therefore, we hope that we can remind clinicians considering by discussing common features of disseminated Nocardia farcinica infection.

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Nocardia farcinica Brain Abscess in an Immunocompetent Host With Pulmonary Alveolar Proteinosis: A Case Report and Review of the Literature

Cited by 9 publications

References 18 publications

Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review

Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review

A case report of brain abscess caused by Nocardia farcinica

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

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