Septic arthritis by Nocardia farcinica: Case report and literature review

Abstract

Nocardiosis is a bacterial infection caused by organisms of the Nocardia genus. The disease typically involves the skin, central nervous system or pulmonary system. Very rarely nocardiosis can cause disease of other organs including bone and joints. Nocardiosis is typically a chronic, somewhat indolent infection, occurring in patients with defective cell mediated immunity. We describe a 78-year-old female with right shoulder septic arthritis resulting from Nocardia farcinica with associated involvement of her skin and lungs as well. She was treated with surgical debridement and combination antibiotic therapy. We also share a literature review of bone and joint infection caused by the N. farcinica species, highlighting its rarity. Understanding uncommon manifestations of nocardiosis allows for early recognition and treatment of the condition and optimal patient care.

Keywords: Farcinica; Joint; Nocardia; Nocardiosis; Septic arthritis.

Fig. 1

Axial (left) and coronal (right) views of contrasted computerized tomography of left hand revealing soft tissue ulceration along the ulnar aspect of wrist/proximal hand with subjacent cellulitis and an ill-defined intramuscular abscess extending from the ulceration into the hypothenar musculature.

Fig. 2

Coronal (left) and axial (right) views of contrasted computerized tomography of right shoulder revealing large lobular, multi loculated collections throughout the shoulder involving the rotator cuff musculature both anterior and posterior to the scapula. Moderate amount of fluid within the subacromial bursa and associated punctate densities concerning for subacromial bursitis as well as moderate glenohumeral joint effusion concerning for septic arthritis are also seen.

Fig. 3

Thin beaded branching Gram positive bacilli seen on Gram stain of right shoulder synovial fluid (left) and periscapular abscess (right).

Fig. 4

Two axial views of computerized tomography of chest revealing scattered areas of tiny nodules (left and right), bibasilar effusions (right) and bibasilar posterior infiltrates (right).