Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation:A three-year follow-up

Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.

Interstitial pneumonia combined with nocardia cyriacigeorgica infection:A case report

BACKGROUND Nocardia infection is a relatively uncommon disease,with no reports among patients with interstitial pneumonia.Due to its atypical clinical symptoms and chest computed tomography(CT)findings and the frequent yielding of negative results by conventional cultures,it poses challenges for timely diagnosis and treatment.CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite,accompanied by a 2-wk long duration of headaches.She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine.Chest CT revealed the presence of newly developed round nodules.The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing(mNGS)performed on bronchoalveolar lavage fluid.Targeted antiinfection therapy was initiated,resulting in symptom improvement and radiological resolution,further validating the mNGS results.CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients.Its clinical and radiological manifestations lack specificity,but mNGS can aid in rapidly obtaining pathogenic information.Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.