A Case of Disseminated Nocardiosis by Nocardia brasiliensis after Steroid Injection

Na Ra Yun; Hee Jeong Lee; Su Jin Hong; Jun Lee; Dong-Min Kim; Sook Jin Jang; Ran Hong

doi:10.3947/ic.2011.43.4.367

Journal List > Infect Chemother > v.43(4) > 1035103

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Yun, Lee, Hong, Lee, Kim, Jang, and Hong: A Case of Disseminated Nocardiosis by Nocardia brasiliensis after Steroid Injection

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(4): 367-371.

Published online: 31 August 2011

DOI: https://doi.org/10.3947/ic.2011.43.4.367

A Case of Disseminated Nocardiosis by Nocardia brasiliensis after Steroid Injection

Na Ra Yun¹, Hee Jeong Lee¹, Su Jin Hong¹, Jun Lee¹, Dong-Min Kim¹, Sook Jin Jang², Ran Hong³

¹Department of Internal Medicine, Chosun University, School of Medicine, Gwangju, Korea.

²Department of Laboratory Medicine, Chosun University, School of Medicine, Gwangju, Korea.

³Department of Pathology, Chosun University, School of Medicine, Gwangju, Korea.

Correspondence to Dong-Min Kim, M.D. Department of Internal Medicine, Chosun University, School of Medicine, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel: +82-62-220-3093, Fax: +82-62-234-9653, drongkim@chosun.ac.kr

Received 28 March 2011 Revised 4 May 2011 Accepted 20 May 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nocardiosis in the immunocompromised host is a rare but life-threatening infection. Nocardia farcinica and N. asteroides have been reported as the most common causative pathogens of disseminated nocardiosis. It is well known that infection of N. brasiliensis can cause cutaneous nocardiosis mainly, but is rarely known to cause disseminated nocardiosis. We report a case of disseminated nocardiosis by N. brasiliensis. A 68-year-old male subject with no underlying disease developed painful swelling on both lower legs, as well as dyspnea. He was diagnosed with intramuscular abscess, pneumonia and brain abscess by N. brasiliensis. He underwent incision and drainage for intramuscular abscess, as well as antibiotic therapy, and was successfully treated.

Keywords: Nocardiosis, Disseminated, Steroid injection, N. brasiliensis

Figures and Tables

Figure 1

Chest CT scan shows (A) Focal consolidation in the left upper lobe (1st day of admission). (B) Nearly resoluted lesions (21 days of treatment).

Figure 2

Tibia MRI shows wall enhanced fluid collections at medial heads of both gastrocnemius muscles.

Figure 3

(A) Lung biopsy shows accumulation of amorphous periodic acid-Schiff (+) eosinophilic material in the alveolar lumina (PAS, ×100), (B) Skin biopsy shows exuberant abscess with long, slender, and filametous rods (Grocott's methenamine silver (GMS), ×400).

Figure 4

Brain MRI shows. (A) Ill-defined mass lesion with multiple rim enhancements in the right cerebellar hemisphere and both parietal lobes, (B) Lesion improved on the 90 days after start of treatment.

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