title: Trimethoprim/sulfamethoxazole-resistant Nocardia asteroides causing multiple hepatic abscesses. Successful treatment with ampicillin, amikacin, and limited computed tomography-guided needle aspiration.
abstract: Hepatic abscesses are rarely encountered in disseminated Nocardia infections. Sulfonamides alone or trimethoprim/sulfamethoxazole is often efficacious in treating infections caused by Nocardia asteroides. In vitro resistance of N. asteroides to trimethoprim/sulfamethoxazole is occasionally present. The patient described in this report had disseminated nocardiosis initially manifesting as multiple subcapsular hepatic abscesses. In vitro susceptibility studies demonstrated resistance to trimethoprim/sulfamethoxazole. Subsequent treatment with ampicillin and amikacin in conjunction with computed tomography-guided needle aspiration of several of the hepatic abscesses, surgical drainage of a right pleural empyema, and eventual discontinuation of use of corticosteroids resulted in cure of the infection.
mesh_terms: D000583:Amikacin / Q000627:therapeutic use*; D000667:Ampicillin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004338:Drug Combinations / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007612:Kanamycin / Q000031:analogs & derivatives*; D008100:Liver Abscess / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy / Q000628:therapy*; D009616:Nocardia asteroides; D010403:Penicillin Resistance; D013396:Suction; D013420:Sulfamethoxazole / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D004338:Drug Combinations; D007612:Kanamycin; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D014295:Trimethoprim; D013420:Sulfamethoxazole