Bacteremia and adrenal gland abscess due to Nocardia cyriacigeorgica: a case report and review

Abstract

Background: Nocardia cyriacigeorgica is one of the most common Nocardia species found in human infections, recently reclassified. Even though Nocardia may affect all organs by hematogenous dissemination, bacteremia are uncommon. Among all possible dissemination sites, the involvement of the adrenal glands is particularly rare.

Case presentation: We report here a rare case of Nocardia disseminated infection with notably bacteremia and adrenal gland abscess, in a 77-years-old immunocompetent man. Adrenal gland abscess diagnosis was made by imaging (computerized tomography, magnetic resonance and positron emission tomography scan). A complete regression of all lesions including the left adrenal gland was obtained after 6 months of antibiotics. A review of literature was also performed.

Conclusion: Nocardia bacteremia is a rare event but blood cultures may help to improve detection of Nocardia spp. in a non-invasive way. Adrenal abscess due to Nocardia spp. is very rare with only fourteen cases reported in the literature, but it is a true cause of adrenal masses. Our report suggests that clinician should be aware of this rare location and prioritize a non-invasive diagnosis strategy.

Keywords: Adrenal gland abscess; Bacteremia; Nocardia cyriacigeorgica; Nocardiosis.

Fig. 1

Abdominal CT and MR scan. Abdominal CT scan [1] in axial view, initial (1A) and 6 months after starting antibiotic treatment (1B). The large left adrenal abscess (white arrow) is accompanied by inflammation of the surrounding fat (blue arrow). Note the normalization of the left adrenal gland (red arrow) and the disappearance of the inflammation of the surrounding fat. MR images [2] acquired during the antibiotic treatment. The T2 with fat saturation images (2A) shows a hypersignal in the anterior part of the left adrenal gland (orange arrow). On the enhanced T1 sequence (2B), this image is not enhanced (white arrow) corresponding to the central part of the abscess (necrosis), while the rest of the adrenal gland is normally enhanced (purple arrow). The hypersignal in diffusion sequence (3C, green arrow), especially with a very low ADC (apparent diffusion coefficient) (3D), here less than 0.5·10^− 6mm² s^− 1 (yellow arrow), leading to the diagnosis of abscess