SHM Converge Scientific Abstract ePoster Gallery-A Fatal Case of Disseminated Nocardiosis Masquerading as Renal Malignancy

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This case report describes a fatal episode of disseminated nocardiosis in an 86-year-old woman with a history of mantle cell lymphoma in remission after rituximab/bendamustine and ibrutinib, placing her at increased risk for opportunistic infection. She presented with generalized weakness, nausea, and shortness of breath. Initial labs showed abnormal liver enzymes, and abdominal imaging revealed a 4.2 cm left renal mass suspicious for malignancy. Staging studies further showed multiple enhancing brain lesions with vasogenic edema and multiple lung nodules, strongly suggesting metastatic renal cell carcinoma.<br /><br />However, kidney biopsy was negative for cancer and instead showed purulent inflammation and necrosis. After discharge, she was quickly readmitted with sepsis. Blood cultures from the prior hospitalization grew Nocardia species, later identified as Nocardia cyriacigeorgica, and repeat renal biopsy confirmed nocardial infection. She was treated with a three-week inpatient course of trimethoprim-sulfamethoxazole, imipenem, and amikacin, then discharged on trimethoprim-sulfamethoxazole and linezolid based on susceptibility results. Despite therapy, imaging remained stable, and she ultimately died from her illness.<br /><br />The report emphasizes that disseminated nocardiosis involves two or more non-contiguous organs and can closely mimic metastatic cancer, leading to diagnostic delay. CNS involvement and Nocardia bacteremia are associated with worse outcomes. Because Nocardia grows slowly and may be difficult to detect, clinicians must maintain a high index of suspicion, especially in immunocompromised patients. Treatment typically requires prolonged, staged therapy, with surgical intervention considered if brain lesions fail to improve radiographically.

Asset Subtitle

Andikan E. Udoh

Meta Tag

Author List Andikan E. Udoh, Breanna Campbell, Hailey Tarleton, Kubiat Udoh, Kuseme Udoh, Vishal Busa

Category Clinical Vignettes

Concept Disseminated Nocardiosis

Concept Nocardia

Concept Immunocompromised State

Concept Metastatic Cancer

Concept Central Nervous System Involvement

Distinguished Non-Finalist

Presenter Organization Baton Rouge General Medical Center

Presenting Author Andikan E. Udoh

Track Adult

Keywords

disseminated nocardiosis

Nocardia cyriacigeorgica

immunocompromised patient

mantle cell lymphoma

opportunistic infection

renal mass

brain lesions

metastatic cancer mimic

trimethoprim-sulfamethoxazole

central nervous system involvement

Disseminated Nocardiosis

Nocardia

Immunocompromised State

Metastatic Cancer

Central Nervous System Involvement