Unusual presentation of disseminated Nocardia abscessus infection in a patient with AIDS

BMJ Case Rep. 2016 Jul 20:2016:bcr2016215649. doi: 10.1136/bcr-2016-215649.

Abstract

A 40-year-old man with AIDS presented with symptoms of a chronic cough, subacute headache, generalised weakness with falls, urinary and faecal incontinence, and acute onset subcutaneous nodules. A chest CT scan showed multiple cavitary and nodular pulmonary infiltrates. MRI of his brain and spinal cord revealed innumerable ring-enhancing lesions. Pathological examination of the purulent material obtained from his subcutaneous lesions, as well as transbronchial tissue specimens obtained by biopsy, revealed beaded and branching Gram-positive rods, subsequently identified by 16S RNA sequencing to be Nocardia abscessus species. We observed an excellent therapeutic response to a combination antimicrobial therapy with resolution of the subcutaneous, pulmonary and central nervous system (CNS) lesions. Infections caused by N. abscessus are rare and typically occur in immunocompromised patients. In this article, we will review the presentation, diagnosis and treatment of N. abscessus infection.

Publication types

  • Case Reports

MeSH terms

  • Abscess / complications*
  • Abscess / diagnosis*
  • Abscess / drug therapy
  • Acquired Immunodeficiency Syndrome / complications*
  • Acquired Immunodeficiency Syndrome / diagnosis*
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Adult
  • Anti-Infective Agents / therapeutic use
  • Biopsy
  • Brain / microbiology
  • Brain / pathology
  • Diagnosis, Differential
  • Humans
  • Immunocompromised Host
  • Lung / microbiology
  • Lung / pathology
  • Magnetic Resonance Imaging
  • Male
  • Nocardia Infections / complications*
  • Nocardia Infections / diagnosis*
  • Nocardia Infections / drug therapy
  • Tomography, X-Ray Computed

Substances

  • Anti-Infective Agents