SHM Converge Scientific Abstract ePoster Gallery-The Unexpected Arrival: Nocardia Beijingensis in a Patient With No Travel History

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This report describes a rare case of <strong>Nocardia beijingensis</strong> infection in the United States, notable because the patient had <strong>no travel history outside the U.S.</strong> Nocardia are soil-dwelling bacteria that can cause serious opportunistic infections, especially in immunocompromised people. N. beijingensis was first identified in Beijing in 2001 and has only rarely been reported in the U.S.

The case involves a <strong>37-year-old man with HIV</strong>, not taking antiretroviral therapy, who presented with <strong>2 months of flu-like symptoms and weight loss</strong>, followed by <strong>2 days of confusion</strong>. On exam, he was hemodynamically stable but had <strong>left lung crepitations</strong> and a <strong>small ulcer on the chin</strong>. Laboratory studies showed <strong>acute kidney injury</strong>, severe <strong>hyperkalemia</strong>, and <strong>metabolic acidosis</strong>, requiring emergency dialysis. His <strong>absolute CD4 count was severely low</strong>, and blood cultures were negative.

Imaging of the chest showed <strong>multifocal pneumonia</strong>, with findings concerning for <strong>necrotizing pneumonia</strong> on the left, including <strong>dense consolidation, cavitation, and air bronchograms</strong>. The diagnosis was ultimately confirmed by <strong>next-generation sequencing</strong> and <strong>bronchoalveolar lavage culture</strong> identifying <strong>Nocardia beijingensis</strong>.

Treatment included <strong>ceftriaxone, minocycline, and linezolid</strong> for at least 3 months, followed by <strong>monotherapy for at least 6 months</strong>, with adjustments based on susceptibility testing. The report emphasizes that nocardiosis can present with <strong>nonspecific symptoms</strong> but carries a <strong>high mortality risk</strong>, making early diagnosis essential. It also highlights diagnostic methods such as <strong>Gram stain, modified acid-fast stain, culture, PCR, and 16S rRNA sequencing</strong>, and notes that prolonged therapy, often <strong>6–12 months</strong>, is generally required, especially in severe or disseminated disease.

Asset Subtitle

Shristi Nepal

Meta Tag

Author List Archana Regmi, Ivonne De La Hoz, Shristi Nepal, Swarnima Rijal, Yu Ya Nway

Category Clinical Vignettes

Concept Nocardia beijingensis

Concept Nocardiosis

Concept Immunocompromised State

Concept Acid-Fast Staining

Concept Culture

Distinguished Non-Finalist

Presenter Organization Hartford Hospital

Presenting Author Shristi Nepal

Track Adult

Keywords

Nocardia beijingensis

nocardiosis

HIV

immunocompromised

necrotizing pneumonia

bronchoalveolar lavage

next-generation sequencing

acute kidney injury

linezolid

antibiotic therapy

Nocardia beijingensis

Nocardiosis

Immunocompromised State

Acid-Fast Staining

Culture