First reported case of disseminated Nocardia kroppenstedtii sp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment

BMJ Case Rep. 2017 Jan 6;2017:bcr2016217337. doi: 10.1136/bcr-2016-217337.

Abstract

A 72-year-old man with a history of blastoid variant stage IV relapsed refractory mantle cell lymphoma presented with new central nervous system (CNS) symptoms. Brain imaging was positive for rim-enhancing lesions along with a mitral valve mass on the echocardiogram. It was a challenge to establish the exact aetiology of these lesions in this patient. He was empirically treated with chemotherapy on the presumption that the brain lesions were secondary to progressive malignancy. However, brain biopsy was negative for malignancy and blood cultures were found positive for Nocardia kroppenstedtii sp nov. He subsequently improved with antibiotic therapy. Disseminated Nocardia can present with multiorgan involvement. Clinical and microbiological diagnosis can be challenging. Antimicrobial treatment-related side effects require close monitoring, and dosage changes or therapy adjustments may be necessary.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Infective Agents / therapeutic use
  • Brain Abscess / complications
  • Brain Abscess / diagnosis*
  • Brain Abscess / drug therapy
  • Diagnosis, Differential
  • Drug Combinations
  • Echocardiography
  • Endocarditis, Bacterial / diagnosis*
  • Endocarditis, Bacterial / drug therapy
  • Endocarditis, Bacterial / microbiology
  • Fatal Outcome
  • Humans
  • Immunocompromised Host
  • Lymphoma, Mantle-Cell / complications*
  • Magnetic Resonance Imaging
  • Male
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / drug therapy
  • Mitral Valve Insufficiency / microbiology
  • Multimodal Imaging
  • Nocardia Infections / complications
  • Nocardia Infections / diagnosis*
  • Nocardia Infections / drug therapy
  • Opportunistic Infections / complications
  • Opportunistic Infections / diagnosis*
  • Opportunistic Infections / drug therapy
  • Sulfadoxine / therapeutic use
  • Tomography, X-Ray Computed
  • Trimethoprim / therapeutic use

Substances

  • Anti-Infective Agents
  • Drug Combinations
  • trimethoprim, sulfadoxine drug combination
  • Sulfadoxine
  • Trimethoprim