Nocardiosis in glomerular disease patients with immunosuppressive therapy

Abstract

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.

Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review

“…In our study, nodule/mass and consolidations were the major radiologic manifestations in NS patients with Nocardia infections, consistent with the previous single-center review ( Guo et al., 2020 ; Han et al., 2020 ). A retrospective study of Cushing’s syndrome with nocardiosis reported that cavitary lesions and nodules were the most common radiological findings ( Zhang et al., 2021 ), indicating that the main radiologic manifestations may have slight differences in different diseases.…”

“…Han et al. ( Han et al., 2020 ) proposed that pulmonary abscesses were important signs of nocardiosis in glomerular disease patients, whereas only 4 patients (case 2, 4, 25, 27) presented with pulmonary abscesses in our review. Therefore, further studies with more cases are needed to assess if pulmonary abscesses were important characteristics in NS patients and the radiological differences between NS patients and other nocardiosis.…”

“…Ten articles described 24 cases that had sufficient individual patient data. Table S2 summarizes these publications ( Hwang et al., 2004 ; Sirijatuphat et al., 2013 ; Zhou et al., 2014 ; Chen et al., 2016 ; Zhu et al., 2017 ; Xu et al., 2018 ; Guo et al., 2020 ; Han et al., 2020 ; Sah et al., 2020 ; Yang et al., 2020 ). A total of 27 cases of nocardiosis with NS were assessed, including the three cases of nocardiosis in our hospital.…”

“…Nocardia infection in NS patients was first described in 1962 by Kerbel NC ( Kerbel, 1962 ). Only a few case reports of Nocardia infection in NS patients are available up to now, and the two latest single-center literature reviews were published in 2020 ( Guo et al., 2020 ; Han et al., 2020 ). However, there are hardly any multicenter retrospective reviews.…”

Perinatal Garlic Oil Supplementation Averts Rat Offspring Hypertension Programmed by Maternal Chronic Kidney Disease

“…Although Nocardia spp. are opportunistic bacteria related to kidney disease and hypertension in humans [ 35 ], the association between high BP and a high Nocardia abundance was addressed, for the first time, by our study.…”