Nocardia elegans infection: a case report and literature review.
A case of disseminated nocardiosis caused by Nocardia elegans in a 72-year-old man with rheumatoid arthritis, treated with tacrolimus and prednisolone, is reported herein. The patient had impaired vision and was diagnosed with endophthalmitis and an abdominal skin abscess. He was started on trimethoprim-sulfamethoxazole treatment, followed by cefepime. The patient was then switched to a combination of imipenem-cilastatin and minocycline. Although the patient survived as a result of surgery and prolonged antibiotic treatment, he eventually lost vision after the infection became resistant to antibiotic treatment. Molecular analysis of samples from the abscess and vitreous fluid confirmed the extremely rare pathogen N. elegans, which accounts for only 0.3-0.6% of infections caused by Nocardia species. This organism is almost always associated with pulmonary infection, and disseminated infections are rare. As with previously reported norcardial infections, the current case was treated successfully with trimethoprim-sulfamethoxazole, carbapenems, and aminoglycosides. However, the clinical characteristics of this organism remain unclear. Further studies are therefore required to develop more effective treatment protocols for disseminated nocardiosis caused by this problematic pathogen.
Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Electronic address: task300@tokyo-med.ac.jp.
Itaru
I
Nakamura
Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan.
Tomoki
T
Nagakura
Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Hiroaki
H
Fujita
Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Shinji
S
Fukusima
Department of Microbiology, Tokyo Medical University, Tokyo, Japan.
Tohru
T
Gonoi
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009615:Nocardia / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Disseminated; Endophthalmitis; Nocardia elegans; Pneumonia; β-d-Glucan