title: Dual disseminated infection with Nocardia farcinica and Mucor in a patient with systemic lupus erythematosus: a case report.
abstract: BACKGROUND
  Infections remain a major cause of morbidity and mortality in immunocompromised patients and require early diagnosis and treatment. However, correct diagnosis and treatment are often delayed by a multitude of factors. We report what we believe to be the first case of a combined disseminated infection with Nocardia and Mucor in a patient with systemic lupus erythematosus.
  
  
  METHODS
  A 74-year-old Caucasian woman with systemic lupus erythematosus presented with recurrent pneumonia. Despite empirical treatment with antibiotics, her condition gradually deteriorated. Microbiological sampling by thoracoscopy revealed the presence of Nocardia. Despite the institution of therapy for disseminated nocardiosis, she died of multi-organ failure. A post-mortem investigation confirmed nocardiosis, but showed concomitant disseminated mucormycosis infection as well.
  
  
  CONCLUSIONS
  Members of the bacterial genus Nocardia and the fungal genus Mucor are ubiquitous in the environment, have the ability to spread to virtually any organ, and are remarkably resistant to appropriate therapy. Both pathogens can mimic other pathologies both on clinical and radiological investigations. Invasive sampling procedures are often needed to prove their presence. Establishing a timely, correct diagnosis and a specific treatment is essential for patient survival.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. frederik.declerck@ugent.be.
authors.forename: Frederik
authors.initials: F
authors.lastname: de Clerck
authors.forename: Florence
authors.initials: F
authors.lastname: Van Ryckeghem
authors.forename: Pieter
authors.initials: P
authors.lastname: Depuydt
authors.forename: Dominque
authors.initials: D
authors.lastname: Benoit
authors.forename: Patrick
authors.initials: P
authors.lastname: Druwé
authors.forename: Arnika
authors.initials: A
authors.lastname: Hugel
authors.forename: Geert
authors.initials: G
authors.lastname: Claeys
authors.forename: Piet
authors.initials: P
authors.lastname: Cools
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
mesh_terms: D000368:Aged; D060085:Coinfection / Q000209:etiology / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000382:microbiology; D009089:Mucor; D009091:Mucormycosis / Q000150:complications / Q000209:etiology* / Q000382:microbiology; D009102:Multiple Organ Failure / Q000209:etiology; D009615:Nocardia; D009617:Nocardia Infections / Q000150:complications / Q000209:etiology* / Q000382:microbiology