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Case Reports
. 2024 Jun 18;17(6):e259725.
doi: 10.1136/bcr-2024-259725.

Disseminated nocardiosis presenting as a superinfected thyroglossal duct cyst in a patient with diabetes

Anouk Schmid  1 , Nader Ahmad  2 , Sebastian Haubitz  3 , Marlene Maria Speth  4   5
Affiliations
Case Reports

Disseminated nocardiosis presenting as a superinfected thyroglossal duct cyst in a patient with diabetes

Anouk Schmid et al. BMJ Case Rep. .

Abstract

We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Nocardia paucivorans Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.

Keywords: Ear, nose and throat/otolaryngology; Head and neck surgery; Infectious diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Initial CT scan of the head and neck: abscess at the base of the tongue, marked by the arrow.
Figure 2
Figure 2
MRI of the neurocranium after diagnosis of Nocardia paucivorans: lesion in gyrus frontalis, marked by the arrow.
Figure 3
Figure 3
Thoracic CT 8 months after initial diagnosis: persistent nodulus in lingulae, hamartochondroma, marked by the arrow.
Figure 4
Figure 4
Timeline of the course of the disease, x marks the day of cervicotomy in the OR.Author: AS.
See this image and copyright information in PMC

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