Nocardia Infection in an Immunosuppressive Patient With Dermatomyositis

Wu, Yang; Yu, Sheng-nan; Xie, Qibing

doi:10.1097/rhu.0000000000000765

Cited by 2 publications

(3 citation statements)

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“…Compound sulfamethoxazole was effective for nocardiosis in glomerular disease patients and even for disseminated nocardiosis, which was characterized by diminished subcutaneous and pulmonary abscesses as a therapeutic response. It has been suggested that nocardiosis mainly occurs in patients suffering from autoimmune diseases, chronic Abbreviation: WBC White blood cell, N% Percentage of neutrophils, CRP C reactive protein, PCT Procalcitonin, ALB Serum albumin, Sr Serum creatinine, 24 h UP 24-h urinary protein *: P < 0.05, compared to data before treatment; a : All the data in "after treatment" were obtained when antibiotic treatment stopped renal disease, hematological diseases and HIV infection, especially in those who receive glucocorticoids or other immunosuppressive treatments [29,[35][36][37][38]. Here, we observed that all 7 patients with nocardiosis had been receiving glucocorticoids alone or combined with immunosuppressive agents, which is consistent with the previous literature.…”

Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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“…2,3 Patients with PMDM are at a higher risk of acquiring opportunistic infections. 4,5 The possibility of reactivation of TB due to the use of systemic glucocorticoids cannot be ruled out in this patient. To the best of our knowledge, we are the first to report cutaneous TB mimicking PMDM.…”

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confidence: 91%

“…Infections have been proposed as a possible trigger factor for PMDM through molecular mimicry 2,3 . Patients with PMDM are at a higher risk of acquiring opportunistic infections 4,5 . The possibility of reactivation of TB due to the use of systemic glucocorticoids cannot be ruled out in this patient.…”

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confidence: 96%