Limits...
Primary Cutaneous Nocardiosis in a Patient With Nephrotic Syndrome

View Article: PubMed Central - PubMed

ABSTRACT

Nocardia infection is not common in clinical practice and most cases occur as an opportunistic infection in immunocompromised patients.

We report a case of primary cutaneous nocardiosis characterized by multiple subcutaneous abscesses due to Nocardia brasiliensis in a patient with nephrotic syndrome undergoing long-term corticosteroid therapy. The patient was diagnosed with nephrotic syndrome 9 months ago, and mesangial proliferative glomerulonephritis was confirmed by renal biopsy. Subsequently, his renal disease was stable under low-dose methylprednisolone (8 mg/d). All of the pus cultures, which were aspirated from 5 different complete abscesses, presented Nocardia. Gene sequencing confirmed that they were all N. brasiliensis. The patient was cured by surgical drainage and a combination of linezolid and Trimethoprim-Sulfamethoxazole.

The case highlights that even during the period of maintenance therapy with low-dose corticosteroid agents, an opportunistic infection still could occur in patients with nephrotic syndrome.

No MeSH data available.


Gene sequence of N. braisiliensis identified from the pus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998259&req=5

Figure 2: Gene sequence of N. braisiliensis identified from the pus.

Mentions: Treatment: The multiple abscesses were incised and drained. Before identification of the pathogen, we used meropenem empirically. Meanwhile, culture of pus was ordered. All of the pus cultures, which were aspirated from 5 different complete abscesses, presented Nocardia consistently, and gene sequencing (Figure 2) confirmed that they were all N. brasiliensis. Further investigations for disseminated disease, including computed tomography of the chest and the brain, were negative. According to drug susceptibility testing, linezolid and TMP-SMX were employed as antibiotic therapy. In addition, the immunosuppression treatment was not halted at the time of nocardia presentation. After 1 week's treatment, his fever resolved. Three weeks later, the abscesses disappeared, and the incisions or wounds had healed (Figure 1C). The WBC and neutrophils count also went down. After 4 weeks of hospitalization, he was sent home on a 6-month course of oral TMP-SMX therapy. He remains well off all treatments, without recurrence. The clinical course is summarized in Figure 3.


Primary Cutaneous Nocardiosis in a Patient With Nephrotic Syndrome
Gene sequence of N. braisiliensis identified from the pus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998259&req=5

Figure 2: Gene sequence of N. braisiliensis identified from the pus.
Mentions: Treatment: The multiple abscesses were incised and drained. Before identification of the pathogen, we used meropenem empirically. Meanwhile, culture of pus was ordered. All of the pus cultures, which were aspirated from 5 different complete abscesses, presented Nocardia consistently, and gene sequencing (Figure 2) confirmed that they were all N. brasiliensis. Further investigations for disseminated disease, including computed tomography of the chest and the brain, were negative. According to drug susceptibility testing, linezolid and TMP-SMX were employed as antibiotic therapy. In addition, the immunosuppression treatment was not halted at the time of nocardia presentation. After 1 week's treatment, his fever resolved. Three weeks later, the abscesses disappeared, and the incisions or wounds had healed (Figure 1C). The WBC and neutrophils count also went down. After 4 weeks of hospitalization, he was sent home on a 6-month course of oral TMP-SMX therapy. He remains well off all treatments, without recurrence. The clinical course is summarized in Figure 3.

View Article: PubMed Central - PubMed

ABSTRACT

Nocardia infection is not common in clinical practice and most cases occur as an opportunistic infection in immunocompromised patients.

We report a case of primary cutaneous nocardiosis characterized by multiple subcutaneous abscesses due to Nocardia brasiliensis in a patient with nephrotic syndrome undergoing long-term corticosteroid therapy. The patient was diagnosed with nephrotic syndrome 9 months ago, and mesangial proliferative glomerulonephritis was confirmed by renal biopsy. Subsequently, his renal disease was stable under low-dose methylprednisolone (8 mg/d). All of the pus cultures, which were aspirated from 5 different complete abscesses, presented Nocardia. Gene sequencing confirmed that they were all N. brasiliensis. The patient was cured by surgical drainage and a combination of linezolid and Trimethoprim-Sulfamethoxazole.

The case highlights that even during the period of maintenance therapy with low-dose corticosteroid agents, an opportunistic infection still could occur in patients with nephrotic syndrome.

No MeSH data available.