Purulent pericarditis caused by Nocardia: a case report and literature review

Abstract

Purulent pericarditis caused by Nocardia, a rare opportunistic infection associated with a high mortality, is frequently misdiagnosed as Mycobacterium tuberculosis (MTB) or other bacterial infections. We report a case of Nocardia-induced purulent pericarditis in a patient with acquired immune deficiency syndrome (AIDS). The patient experienced multiple misdiagnoses and received inappropriate anti-tuberculosis therapy. Timely pericardial puncture and subsequent culture of the pericardial effusion identified Nocardia, prompting initiation of appropriate antibiotic therapy which led to clinical cure. This case report underscores the importance of broad differential diagnostic considerations in purulent pericarditis and emphasizes that prompt initiation of Nocardia-directed antibiotic therapy, guided by microbiological identification, is crucial for timely diagnosis and management. Additionally, we review and summarize previously reported cases of laboratory-confirmed Nocardia pericarditis in AIDS patients.

Keywords: AIDS; Nocardia; antibiotic therapy; pericardiocentesis; pericarditis.

Figure 1

Serial imaging changes during hospitalization and follow-up. The upper section displays the mediastinal window, while the lower section represents the lung window. The white arrow points to the effusion of pericardial. (A) Shows the chest CT scan obtained on admission, revealing pericardial effusion and symmetrical pleural effusion with localized atelectasis in the lower lobes of both lungs. (B) Shows Chest CT at discharge demonstrating significant resolution of pericardial effusion with small residual fluid. (C,D) Shows follow-up chest CT scans at the outpatient clinic, demonstrating complete absorption of pericardial effusion and symmetrical pleural effusion.

Figure 2

Clinical timeline of Nocardia purulent pericarditis in an AIDS patient.