[Systemic Nocardia asteroides infection with endocardial involvement in a patient undergoing immunosuppressive therapy].
METHODS
A 62 year-old male patient developed malaise, unproductive cough and high temperature (39.5 degrees C) during immunosuppressive therapy with methylprednisolon and cyclosporin A six months after kidney transplantation for glomerulonephritis.


METHODS
Clinical examination revealed an endophthalmitis and chest X ray a left-sided lobar pulmonic infiltration. Computed tomography and magnetic resonance imaging examination performed because of recurrent petit-mal-convulsions demonstrated multiple intracranial infiltrations. Transoesophageal echocardiography revealed floating vegetations up to 8 mm in diameter predominantly attached to the aortic valve. A total of 39 consecutive blood cultures drawn during several days remained sterile. However, Nocardia asteroides (Biovar A1) was isolated from a small cutaneous tumor excised from the right thigh.


METHODS
After initiation of a specific antibiotic treatment with imipenem/cilastatin (each 1 g three times daily), and doxycyclin (100 mg twice daily), computed tomography and magnetic resonance imaging showed a reduction in size and number of the intracranial infiltrations. Neurological symptoms were progressive despite maximal anticonvulsant therapy. The patient died 83 days after hospital admission from an epileptic state resistant to therapy.


CONCLUSIONS
Though nocardiosis is still rare, it should early be included in the differential diagnosis of infections in immunocompromised patients to allow timely diagnosis and therapy.
Niehues
R
R
Klinik für Kardiologie, Pneumologie und Angiologie, Universität Düsseldorf.
Schlüter
S
S
Kramer
A
A
Klein
R M
RM
Strauer
B E
BE
Schaal
K P
KP
Horstkotte
D
D
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications; D015377:Cilastatin / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy / Q000209:etiology*; D009616:Nocardia asteroides / Q000302:isolation & purification; D011014:Pneumonia / Q000150:complications; D011480:Protease Inhibitors / Q000627:therapeutic use; D013226:Status Epilepticus / Q000209:etiology; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D016572:Cyclosporine; D004318:Doxycycline; D008775:Methylprednisolone
Systemische Nocardia-asteroides-Infektion mit Endokardbeteiligung unter immunsuppressiver Therapie.