title: Successful Short-Term Intravenous Treatment of Disseminated Nocardia farcinica Infection with Severe Hyponatremia After Kidney Transplantation: A Case Report.
abstract: BACKGROUND
  Nocardia is a genus of gram-positive Actinomycetes that are ubiquitous in decaying organic material, soil, and water. Some Nocardia species can infect humans, mainly by airborne transmission. Several reports describe disseminated infections, which are rare and mostly affect strongly immunocompromised patients because intact T-cell-mediated immunity is the major protective mechanism.
  
  
  METHODS
  We report a case of disseminated pulmonary, cerebral, and cutaneous infection with Nocardia farcinica in a 66-year-old kidney transplant recipient treated with low-dose triple immunosuppression. The patient was initially admitted because of severe hyponatremia and pneumonia with radiologic signs of pleural effusion. The infectious agent was isolated when cutaneous lesions developed. Oral trimethoprim/sulfamethoxazole treatment led to severe hyponatremia; therefore, long-term treatment with parenteral amikacin and minocycline was initiated. After 7 months of consistent intravenous treatment, the lesions completely resolved and treatment was stopped, against some expert suggestions. The patient had remained free of relapse at the time of writing.
  
  
  CONCLUSIONS
  Disseminated Nocardia infection in immunocompromised patients is a rare but life-threatening disease. Owing to its infrequency, the variety of clinical patterns, antimicrobial resistance, and often fatal complications of standardized therapy, the diagnosis and treatment of this infection remain challenging and protracted.
authors.affiliation: Division of Nephrology, Medizinische Klinik I, University of Würzburg, Würzburg, Germany. Electronic address: herzog_a1@ukw.de.
authors.forename: A L
authors.initials: AL
authors.lastname: Herzog
authors.affiliation: Division of Nephrology, Medizinische Klinik I, University of Würzburg, Würzburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wanner
authors.affiliation: Division of Nephrology, Medizinische Klinik I, University of Würzburg, Würzburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Lopau
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001927:Brain Diseases / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000150:complications / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D010996:Pleural Effusion / Q000150:complications; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination