title: Disseminated nocardiosis: a rare infectious complication following non-heart-beating donor liver transplantation.
abstract: Nocardiosis is an infrequent disease that affects patients who display a cellular immunodeficiency, such as transplant recipients on immunosuppressive treatment, but uncommonly associated with high morbidity and mortality rates. Disseminated Nocardiosis affecting the central nervous system (CNS), abdomen, skin, and lungs has been described in bone marrow, lung, and kidney transplant recipients. However, to our knowledge, no cases involving all of these structures have been reported in liver transplant recipients. Herein, we have reported a case of CNS, pulmonary, and cutaneous nocardiosis in a liver transplant recipient who experienced hepatitis C virus-related cirrhosis and hepatocellular carcinoma and received the organ from a non-heart-beating donor. At posttransplantation month 7 the patient was admitted to the emergency department with poor general health status, fever, edema, and subcutaneous nodules in the legs. A computed tomography scan revealed multiple nodules disseminated through both lungs, abdomen, brain, and subcutaneous tissue. A needle biopsy was performed into one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazole-trimethoprim (SMZ-TMP), shifting after 1 month to oral therapy. Radiological examination performed after 2 weeks of treatment showed a 70% reduction in subcutaneous, pulmonary, and cerebral lesions. After 6 months of SMZ-TMP treatment, the patient remained free of the symptoms with involution of the subcutaneous nodules and significant radiological improvement. Among opportunistic infections appearing in liver transplant recipients, Nocardia species should have special consideration according to the success of early treatment and the bad prognosis in cases of delayed diagnosis.
authors.affiliation: Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain. sfjgm@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Jimenez-Galanes Marchan
authors.forename: J C
authors.initials: JC
authors.lastname: Meneu Díaz
authors.forename: O
authors.initials: O
authors.lastname: Caso Maestro
authors.forename: B
authors.initials: B
authors.lastname: Perez Saborido
authors.forename: A
authors.initials: A
authors.lastname: Moreno Elola-Olaso
authors.forename: M
authors.initials: M
authors.lastname: Abradelo Usera
authors.forename: Y
authors.initials: Y
authors.lastname: Fundora Suarez
authors.forename: A
authors.initials: A
authors.lastname: Gimeno Calvo
authors.forename: V
authors.initials: V
authors.lastname: Moreno Molinero
authors.forename: A
authors.initials: A
authors.lastname: Garcia Reyne
authors.forename: V
authors.initials: V
authors.lastname: Barra Valencia
authors.forename: R
authors.initials: R
authors.lastname: San Juan Garrido
authors.forename: E
authors.initials: E
authors.lastname: Moreno Gonzalez
mesh_terms: D000038:Abscess / Q000382:microbiology; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001926:Brain Death; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000382:microbiology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009615:Nocardia / Q000187:drug effects / Q000302:isolation & purification; D009617:Nocardia Infections / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008775:Methylprednisolone