Disseminated Nocardia infection in a female patient with idiopathic thrombocytopenic purpura and long-term glucocorticoid use

Abstract

Introduction: Nocardiosis is a rare kind of opportunistic infections. Because of its insidious onset and atypical clinical manifestations, diagnosis and early treatment are often delayed. Case presentation: Here we present a 60-year-old Chinese female patient with systemic Nocardia infection, who had been diagnosed with idiopathic thrombocytopenic purpura previously and was misdiagnosed for up to 6 months prior to presenting at our hospital and ultimately achieved clinical cure. Discussion: The patient took prednisone because of ITP for several years which led to immunosuppression. Nocardia infection began from the skin rupture and then spread all over the body with multiple system involvement. The pus culture eventually found Nocardia. Sulphonamides have been the standard treatment for decades and there are several other options. Patients with severe Nocardia infection or immunosuppression are suggested a combined therapy. Conclusion: Nocardiosis is an infection that often resulted in delayed diagnosis because of lack of specificity of the clinical profile and the difficulty in culturing the bacteria. It should be included in the differential diagnosis of patients in which there are cutaneous, respiratory or neurological manifestations, especially in immunosuppressed individuals.