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Review
. 2009 Dec 2:9:194.
doi: 10.1186/1471-2334-9-194.

Abscess of adrenal gland caused by disseminated subacute Nocardia farcinica pneumonia. A case report and mini-review of the literature

Michael Tachezy  1 , Philipp Simon, Corina Ilchmann, Yogesh K Vashist, Jakob R Izbicki, Karim A Gawad
Affiliations
Review

Abscess of adrenal gland caused by disseminated subacute Nocardia farcinica pneumonia. A case report and mini-review of the literature

Michael Tachezy et al. BMC Infect Dis. .

Abstract

Background: Infections caused by Nocardia farcinica are uncommon and show a great variety of clinical manifestations in immunocompetent and immunocompromised patients. Because of its unspecific symptoms and tendency to disseminate it may mimic the clinical symptoms and radiologic findings of a tumour disease and the diagnosis of nocardiosis can easily be missed, because there are no characteristic symptoms.

Case presentation: We present a case of an adrenal gland abscess caused by subacute disseminated N. farcinica pneumonia.

Conclusion: An infection with N. farcinica is potentially lethal because of its tendency to disseminate -particularly in the brain- and its high resistance to antibiotics. Awareness of this differential diagnosis allows early and appropriate treatment to be administered.

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Figures

Figure 1
Figure 1
Thorax x-ray with diffuse small nodules and in some parts also confluent infiltrations; pleural effusion on the left side.
Figure 2
Figure 2
(A) Contrast-enhanced Coronal CT image of the abdomen shows a 6 cm large suprarenal, contrast enhancing tumour with central septet necrosis (→) (B) Coronal image shows infiltration of the Vena cava inferior and inside a 3-4 cm long thrombus (→). In addition an infiltration of the hepatic and renal capsule as well as the diaphragm is shown.
Figure 3
Figure 3
(A) Cultured Nocardia farcinica present as Gram-positive, beaded, thin, branching, Gram-positive rods (Kinyoun-staining, Original magnification ×1000) (B) Histological findings of the adrenal gland were a large necrotic and chronic putrid abscess formation (→) (H&E-staining, Original magnification × 10).
Figure 4
Figure 4
Contrast enhanced T1w MR Image shows the cranial abscesses in the right fronto-parietal white matter with the surrounding edema (→) and a further small abscess in the left gyrus frontalis superior.
See this image and copyright information in PMC

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