Fulminant Nocardia Colitis: A Case Report

Abstract

Background: Nocardia infection is a rare but well-recognized side effect of immunosuppressive therapy including tumor necrosis factor-α (TNF-α) antagonists. However, Nocardia colitis has only been previously reported once in the English literature. Case Report: We present a 58-y-old female with history of Crohn disease maintained on multiple medications including infliximab (a TNF-α antagonist). The patient presented to the emergency department with hematochezia and abdominal pain. Computed tomography (CT) scan revealed extensive pneumotosis throughout the bowel as well as mesenteric and portal venous gas. She underwent an exploratory laparotomy that revealed bowel edema without ischemia. No bowel was resected and at a planned second-look laparotomy 48 h later, the bowel appeared normal and the abdomen was closed. Post-operatively, the patient tested negative for Clostridium difficile infection. The blood and abdominal fluid cultures were positive for Nocardia farcinica. Conclusion: The patient had a complicated post-operative course and developed multiple hospital-acquired infections. However, she survived and was placed in sub-acute rehabilitation four weeks after the acute surgical intervention.