Disseminated Nocardia brasiliensis infection: an unusual complication of immunosuppressive treatment for childhood dermatomyositis.
The use of steroids combined with cytotoxic drugs has increased in the last decade. The concomitant increase of opportunistic infections has contributed significantly to morbidity and mortality of patients treated with immunosuppressive agents. We describe a child with dermatomyositis who developed disseminated Nocardia brasiliensis infection while receiving steroids and methotrexate. Infectious etiology was established by gram stain. The patient was treated successfully. Disseminated Nocardia brasiliensis infection is rare with a high reported mortality. Diagnosis may be delayed secondary to insidious onset, similarity of clinical manifestations to other pathogens and slow growth in routine culture media. Nocardia should be considered early in the evaluation of infection in patients treated with immunosuppressive agents.
Division of Pediatric Rheumatology, Floating Hospital for Infants and Children, New England Medical Center, Boston, MA 02111.
M S
MS
Klein-Gitelman
I S
IS
Szer
D000293:Adolescent; D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008171:Lung Diseases / Q000382:microbiology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000209:etiology*; D012871:Skin Diseases / Q000382:microbiology; D013256:Steroids / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D013256:Steroids; D008727:Methotrexate