Disseminated Nocardiosis: A Case Report

Abstract

Disseminated nocardiosis is a rare infection associated with underlying immunosuppression, and patients usually have some identifiable risk factor affecting cellular immunity. Due to advances in taxonomy and microbiology identification methods, infections by Nocardia species are more frequent, making the discussion of its approach and choice of antibiotherapy increasingly relevant. A 77-year-old man presented to the emergency department with marked pain on the right lower limb, weakness, and upper leg edema. He had been diagnosed with organized cryptogenic pneumonia one year before and was chronically immunosuppressed with methylprednisolone 32 mg/day. Blood cultures isolated Nocardia cyriacigeorgica. Computed tomography revealed a gas collection in the region of the right iliacus muscle with involvement of the gluteal and obturator muscles upwardly and on the supragenicular plane inferiorly. Triple therapy with imipenem, amikacin, and cotrimoxazole was started, and the patient was submitted for emergent surgical decompression, fasciotomy, and drainage due to acute compartment syndrome. The patient had a good outcome and was discharged from the hospital after 30 days of intravenous therapy. This case illustrates the severity of Nocardia infection and highlights the need for a meticulous approach in the diagnosis and treatment of these patients.

Keywords: immunosuppression; nocardia; nocardia infection.

Figure 1. Right lower limb CT scan, frontal plane

Right lower limb computerized tomography scan, frontal plane, revealing a gas collection in the region of the right iliacus muscle

Figure 2. Right lower limb CT scan, sagittal plane

Right lower limb computerized tomography scan, sagittal plane, revealing a gas collection in the region of the right iliacus muscle

Figure 3. Chest X-ray, posteroanterior view

Chest X-ray, posteroanterior view, on the second admission, showing residual image of organized cryptogenic pneumonia of the right lung, the patient had the year before

Figure 4. Chest X-ray, lateral view

Chest X-ray, lateral view, on the first admission, with residual aspects of organized cryptogenic pneumonia of the right lung the patient had the year before

Figure 5. Thoracic CT scan

Thoracic computerized tomography scan with cavitation with 3,3 x 3,2 cm on the anterior area of the left upper lobe