Chest Infections |

Disseminated Nocardia veterana FREE TO VIEW

Lindsay Somerville, MD; Elizabeth Gay, MD
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University of Virginia, Charlottesville, VA

Chest. 2015;148(4_MeetingAbstracts):161A. doi:10.1378/chest.2230253
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SESSION TITLE: Infectious Disease Cases II

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM

INTRODUCTION: Nocardia veterana is a rare pathogen in the Nocardiaceae family, once thought to be of little clinical significance. However, it has been implicated in pulmonary infections and rarely described as a central nervous system pathogen. Here we present a case of disseminated nocardia veterana with pulmonary, ocular, and CNS involvement in an immunocompromised woman.

CASE PRESENTATION: A 58 year old woman presented with two months of generalized weakness, decreased level of consciousness, blurred vision, and shortness of breath with productive cough. She had initiated therapy with high dose systemic corticosteroids and methotrexate three months prior to admission for a flare of dermatomyositis. Exam revealed expressive aphasia, generalized weakness, crackles in the lung bases, and pitting lower extremity edema. Computerized tomography of the chest revealed bilateral cavitary lung lesions in all lobes. An MRI of the brain and spine demonstrated innumerable 5-35 mm peripherally enhancing lesions in the cerebellum and supratentorial brain, cervical spine, and right brachial plexus. Lung and cerebellar biopsies grew nocardia veterana. Symptoms improved with intravitreal ceftazidime for ocular involvement, six weeks of systemic meropenem and sulfamethoxazole-trimethoprim, and aggressive physical rehabilitation. Follow up imaging revealed interval improvement of the abscesses.

DISCUSSION: Nocardiaceae is a family of ubiquitous, soil-borne actinomycetes, commonly introduced via direct inhalation of bacteria. Infection is often subclinical, transient, and limited to the respiratory tract. Widespread infection is rare, but can occur by hematogenous spread, particularly in immunocompromised hosts with defects in cellular immunity. Symptoms of disseminated disease often mimic tuberculosis, malignancy, and fungal infection.

CONCLUSIONS: Nocardia veterana is a rarely isolated soil-borne aerobic actinomycete. Although an uncommon cause of CNS infections, it should be considered in the differential of widespread abscesses in patients with defects in cellular immunity.

Reference #1: Al-Tawfiq JA, Al-Khatti AA. Disseminated systemic Nocardia farcinica infection complicating alefacept and infliximab therapy in a patient with severe psoriasis. Int J Infect Dis. 2010;14: e153-e157.

Reference #2: Lerner PI. Nocardiosis. Clinical Infectious Diseases 1996;22:891-905.

Reference #3: Ansari SR, et al. Nocardia veterana bloodstream infection in a patient with cancer and a summary of reported cases. Int J Infect Dis. 2006;10(6): 483-486.

DISCLOSURE: The following authors have nothing to disclose: Lindsay Somerville, Elizabeth Gay

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