Abstract
Nocardia is an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection. Nocardia mikamii has been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.
Highlights
Nocardia mikamii has been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis in an immunocompromised patient
Nocardiosis is an uncommon Gram-positive bacterial infection caused by genus Nocardia of aerobic actinomycetes
The bacteria causes’ disease in immunocompromised patients, but approximately up to one-third infection can occur in immunocompetent patients [1]
Summary
Patient reported progressive fatigue and shortness of breath around the same time He had past medical history of idiopathic thrombocytopenic purpura (ITP) diagnosed 6 weeks back and was on prednisone at the time of presentation. Review of system was remarkable for progressive nonproductive cough and diffuse headache On admission his Temp = 36.7∘C, P = 77/min, BP: 140/79 mmHg, RR = 14/min, and saturation 98% on 2L nasal cannula. Chest X-ray on admission showed left upper consolidation (see Figure 1). Patient finished 5 weeks of induction with triple antibiotic therapy with a good clinical response. At this point bacterial susceptibilities were available which showed the bacteria were resistant to tobramycin and amoxicillin-clavulanate, but susceptible to trimethoprimsulfamethoxazole and imipenem.
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