Nocardia cyriacigeorgica bacteraemia presenting with cytomegalovirus disease and rapidly fatal pneumonia in a renal transplant patient: a case report

Simon Namnyak,Nadia Ahmod,Mashuk Uddin

doi:10.1186/1752-1947-5-228

Abstract

IntroductionNocardia cyriacigeorgica bacteraemia has been described in the setting of profound immunodeficiency in only two previous case reports. In both instances, diagnosis was rapidly facilitated by 16S rRNA gene sequencing of blood culture isolates. To the best of our knowledge, we believe that our case is the first presentation of N. cyriacigeorgica bacteraemia associated with acute cytomegalovirus disease in a kidney transplant recipient, which was then followed by severe and fatal pneumonia only seven days later.Case presentationWe present the case of a 73-year-old Caucasian woman, a renal transplant recipient, with peripheral vascular disease, hypertension, osteoporosis and vascular dementia who was diagnosed with septicemia and pneumonia. In spite of appropriate anti-microbial therapy for nocardial sepsis, she developed severe pneumonia and acute renal failure.ConclusionThis case illustrates a potential for disseminated nocardial infection to produce clinical syndromes that may be indistinguishable from acute cytomegalovirus disease. An atypical presentation (pneumonia and renal failure) of a rare disease (nocardial septicemia) in the setting of renal transplantation is discussed. This case illustrates that the possibility of severe cytomegalovirus disease should be considered in renal transplanted patients diagnosed with nocardial septicemia who subsequently develop severe sepsis, pneumonia, and renal failure. Molecular diagnosis should readily be available to assist with the prompt diagnosis and treatment of these infections in renal transplant patients.

Highlights

Nocardia cyriacigeorgica bacteraemia has been described in the setting of profound immunodeficiency in only two previous case reports
This case illustrates a potential for disseminated nocardial infection to produce clinical syndromes that may be indistinguishable from acute cytomegalovirus disease
An atypical presentation of a rare disease in the setting of renal transplantation is discussed. This case illustrates that the possibility of severe cytomegalovirus disease should be considered in renal transplanted patients diagnosed with nocardial septicemia who subsequently develop severe sepsis, pneumonia, and renal failure

Summary

Conclusion

N. cyriacigeorgica septicemia and pneumonia in a kidney transplant recipient, co-existing with CMV disease, is rarely reported and may be difficult to diagnose with traditional microbiological methods. Co-existing CMV disease and infections should be diagnosed promptly with CMV PCR to assist with the early treatment and/or prophylaxis with valganciclovir. This case contributes to the spectrum of diseases that may be seen in immune-suppressed patients after kidney transplantation. Author details 1Department of Medical Microbiology, Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, RM7 0AG, Essex, UK. Authors’ contributions SN, lead and corresponding author, managed this patient clinically, and helped to draft the manuscript and performed the literature review. MU managed the patient clinically, and helped to draft the manuscript and performed the literature review. Competing interests The authors declare that they have no competing interests

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