SHM Converge Scientific Abstract ePoster Gallery-Challenges in Knocking Out Nocardia, a Systemic Invader

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This case highlights the diagnostic and therapeutic challenges of disseminated nocardiosis in an immunocompromised patient. Nocardia infection most often affects patients within 1–2 years of organ transplantation and commonly spreads to the central nervous system, skin/soft tissue, lungs, and other organs. Because blood cultures are often negative, diagnosis depends on microbiologic culture from infected sites, and early brain imaging is recommended when nocardiosis is suspected.<br /><br />A 68-year-old man with a kidney transplant and chronic immunosuppression presented with hypotension and severe right leg pain from an abscess. CT imaging showed multiple additional abscesses in the neck, forearm, retroperitoneum, paravertebral region, and lungs. Brain imaging obtained several days after admission revealed vasogenic edema and a 23 mm cerebral abscess. Blood cultures were negative, so abscess drainage cultures were sent. Gram stain later showed gram-positive rods, prompting empiric treatment for nocardiosis with imipenem, linezolid, and moxifloxacin. Culture eventually confirmed Nocardia farcinica, and trimethoprim-sulfamethoxazole was added based on sensitivities.<br /><br />Despite antibiotic therapy, the patient developed persistent weakness and possible hemorrhage within the brain abscess. He underwent aspiration of the cerebral abscess, but his condition worsened after surgery and he died.<br /><br />The case underscores that immunocompromised patients with multiple abscesses and negative blood cultures should raise concern for disseminated Nocardia. Early recognition, culture-based diagnosis, prompt imaging, prolonged antimicrobial therapy, and source control are essential, but mortality remains high, especially with CNS involvement.

Asset Subtitle

Yan Xing

Meta Tag

Author List Kaitlyn P. Lew, Kevin Kwak, Yan Xing

Category Clinical Vignettes

Concept Nocardiosis

Concept Microbiologic Culture

Concept Immunocompromised State

Concept Central Nervous System Involvement

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Yan Xing

Track Adult

Keywords

disseminated nocardiosis

immunocompromised patient

kidney transplant

Nocardia farcinica

brain abscess

multiple abscesses

negative blood cultures

gram-positive rods

antimicrobial therapy

central nervous system involvement

Nocardiosis

Microbiologic Culture

Immunocompromised State

Central Nervous System Involvement

Antibiotic Therapy