An unusual case of Nocardia cyriacigeorgica presenting with spinal abscesses in a renal transplant recipient and a review of the literature

Transpl Infect Dis. 2019 Feb;21(1):e13025. doi: 10.1111/tid.13025. Epub 2018 Nov 27.

Abstract

Nocardia species represent a well-recognized yet uncommon cause of opportunistic infections in humans. It most frequently presents as a pulmonary infection with or without central nervous system involvement. It is a very rare cause of spinal abscesses, with only 26 cases reported in the literature. Here we report a 49-year-old man with a history of renal transplantation who presented with low back pain and was diagnosed with epidural and paraspinal abscesses due to Nocardia cyriacigeorgica that was successfully treated with antimicrobial therapy alone. In addition to the case reported here, we also conducted a systematic review of the existing literature regarding spinal abscesses due to Nocardia species and examined the success of the various treatments utilized.

Keywords: Nocardia; Nocardia cyriacigeorgica; nocardiosis; renal transplant; spinal abscess.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Intravenous
  • Anti-Bacterial Agents / therapeutic use
  • Epidural Abscess / complications
  • Epidural Abscess / diagnosis*
  • Epidural Abscess / microbiology
  • Epidural Abscess / pathology
  • Humans
  • Kidney Transplantation / adverse effects*
  • Low Back Pain / diagnosis
  • Low Back Pain / etiology
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / microbiology*
  • Lumbar Vertebrae / pathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nocardia / isolation & purification
  • Nocardia Infections / diagnosis*
  • Nocardia Infections / microbiology
  • Nocardia Infections / pathology
  • Opportunistic Infections / diagnosis*
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / pathology
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents