Disseminated Nocardia in an Immunocompetent Host
نویسندگان
چکیده
A 44-year-old man with no medical comorbidities presented recurrent inferior vena cava thrombosis and several months of fever, headache, weight loss. Positron emission tomography–computed tomography was performed, which revealed a 1.5-cm fluorodeoxyglucose avid left lung mass hypermetabolic soft tissue masses in bilateral inguinal regions (Figure 1). He underwent computed tomography–guided biopsy the masses. Histopathology found clumps filamentous branching bacilli, consistent Nocardia (Supplemental Figure, available online at http://www.mayoclinicproceedings.org). Broad-range bacterial polymerase chain reaction (16s rRNA detection) returned positive for paucivorans. Subsequent brain magnetic resonance imaging exhibited innumerable abscesses 2). Immunodeficiency work-up performed unremarkable. began therapy intravenous trimethoprim-sulfamethoxazole, amikacin, imipenem.Figure 2Abscesses surrounding vasogenic edema on T2-weighted fluid-attenuated inversion recovery imaging.View Large Image Figure ViewerDownload Hi-res image Download (PPT) is filamentous, Gram-positive, partially acid-fast bacterium that ubiquitous environment.1Lerner P.I. Nocardiosis.Clin Infect Dis. 1996; 22: 891-903Crossref PubMed Scopus (499) Google Scholar It capable disseminating to almost any organ, but it has predilection lungs brain. also tendency recur. Disseminated infection more common immunocompromised hosts, approximately one-third infections occur patients who are immunocompetent.2Corti M.E. Villafañe-Fioti M.F. Nocardiosis: review.Int J 2003; 7: 243-250Abstract Full Text PDF (170) Scholar, 3Dominguez D.C. Antony S.J. Actinomyces nonimmunocompromised patients.J Natl Med Assoc. 1999; 91: 35-39PubMed 4Sorrell T.C. Mitchell D.H. Iredell J.R. Chen S.C.-A. species.in: Bennett J.E. Dolin R. Blaser M.J. Mandell, Douglas, Bennett's Principles Practice Infectious Diseases. 8th ed. Elsevier, Philadelphia, PA2015: 2853-2863Crossref (16) Treatment disseminated disease requires induction multidrug therapy. Trimethoprim-sulfamethoxazole forms backbone combined one or both amikacin imipenem. Imipenem required if there central nervous system involvement. should be tailored based susceptibilities, available. After induction, may transitioned dual oral trimethoprim-sulfamethoxazole either minocycline amoxicillin-clavulanate. total 12 typical those involvement.4Sorrell We acknowledge thank Julie Guerin, MD, Ayse Tuba Kendi, interpreting providing images positron tomography, respectively.
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ژورنال
عنوان ژورنال: Mayo Clinic Proceedings
سال: 2021
ISSN: ['1942-5546', '0025-6196']
DOI: https://doi.org/10.1016/j.mayocp.2020.11.019