RESUMEN
ABSTRACT: Brain nocardiosis is an uncommon but severe disease associated with high mortality. We present a case of brain nocardiosis with elevated tracer uptake on both 68 Ga-pentixafor and 18 F-FDG PET/CT, mimicking intracerebral invasion of multiple myeloma. This case demonstrates that nocardiosis should be considered in the differential diagnosis of brain lesions found on PET/CT with increased tracer accumulation in immunocompromised patients.
Asunto(s)
Mieloma Múltiple , Nocardiosis , Tomografía Computarizada por Tomografía de Emisión de Positrones , Humanos , Mieloma Múltiple/diagnóstico por imagen , Nocardiosis/diagnóstico por imagen , Diagnóstico Diferencial , Masculino , Isótopos de Galio , Persona de Mediana Edad , Neoplasias Encefálicas/diagnóstico por imagen , Invasividad Neoplásica , Anciano , Péptidos Cíclicos , Complejos de CoordinaciónRESUMEN
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
Asunto(s)
Absceso Encefálico , Coinfección , Nocardiosis , Nocardia , Humanos , Coinfección/complicaciones , Absceso Encefálico/diagnóstico por imagen , Nocardiosis/diagnóstico , Nocardiosis/diagnóstico por imagen , Encéfalo/diagnóstico por imagenRESUMEN
A woman in her 70s with a history of nodular bronchiectatic Mycobacterium avium complex pulmonary disease (MAC-PD) presented with an exacerbated productive cough and worsening findings on chest imaging. Although repeated sputum culture tests were negative for acid-fast bacilli and only revealed normal respiratory flora, a bronchoscopy identified Nocardia sp. Consequently, she was diagnosed with pulmonary nocardiosis and was successfully treated with levofloxacin. It is known that pulmonary nocardiosis can manifest in immunocompetent individuals with bronchiectasis. For cases of refractory nodular bronchiectatic MAC-PD, it is vital to consider bronchoscopy to identify potential co-infections, such as Nocardia.
Asunto(s)
Bronquiectasia , Enfermedades Pulmonares , Infección por Mycobacterium avium-intracellulare , Nocardiosis , Nocardia , Femenino , Humanos , Complejo Mycobacterium avium , Infección por Mycobacterium avium-intracellulare/complicaciones , Infección por Mycobacterium avium-intracellulare/diagnóstico , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Bronquiectasia/complicaciones , Bronquiectasia/diagnóstico por imagen , Bronquiectasia/tratamiento farmacológico , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/tratamiento farmacológico , Nocardiosis/diagnóstico , Nocardiosis/diagnóstico por imagenRESUMEN
OBJECTIVE: Our study aimed to elucidate the computed tomography (CT) features and follow-up course of pulmonary nocardiosis patients to improve the understanding and diagnostic accuracy of this disease. METHODS: The chest CT findings and clinical data of patients diagnosed with pulmonary nocardiosis by culture or histopathological examination in our hospital between 2010 and 2019 were retrospectively analyzed. RESULTS: A total of 34 cases of pulmonary nocardiosis were included in our study. Thirteen patients were on long-term immunosuppressant therapy, among whom 6 had disseminated nocardiosis. Among the immunocompetent patients, 16 had chronic lung diseases or a history of trauma. Multiple or solitary nodules represented the most common CT feature (n = 32, 94.12%), followed by ground-glass opacities (n = 26, 76.47%), patchy consolidations (n = 25, 73.53%), cavitations (n = 18, 52.94%), and masses (n = 11, 32.35%). There were 20 cases (61.76%) with mediastinal and hilar lymphadenopathy, 18 (52.94%) with pleural thickening, 15 (44.12%) with bronchiectasis, and 13 (38.24%) with pleural effusion. Significantly higher rates of cavitations were observed among immunosuppressed patients (85% vs 29%, P = 0.005). At follow-up, 28 patients (82.35%) clinically improved with treatment, while 5 (14.71%) had disease progression, and 1 (2.94%) died. CONCLUSIONS: Chronic structural lung diseases and long-term immunosuppressant use were found as risk factors for pulmonary nocardiosis. While the CT manifestations were highly heterogeneous, clinical suspicion should be raised upon findings of coexisting nodules, patchy consolidations, and cavitations, particularly in the presence of extrapulmonary infections such as those of the brain and subcutaneous tissues. A significant incidence of cavitations may be observed among immunosuppressed patients.
Asunto(s)
Enfermedades Pulmonares , Nocardiosis , Humanos , Estudios de Seguimiento , Estudios Retrospectivos , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Tomografía Computarizada por Rayos X/métodos , Inmunosupresores/uso terapéuticoRESUMEN
ABSTRACT: We present FDG PET/CT findings of a human immunodeficiency virus-positive patient suspicious for lung cancer with a solitary metastasis to the adrenal gland. Wedge resection of the pulmonary nodules revealed Nocardia infection and a repeat FDG PET/CT imaging after the antibiotic treatment demonstrated complete metabolic response of the adrenal lesion and pulmonary nodules. It should be kept in mind that nocardiosis may present with FDG-avid lesions masquerading as malignancies in immunocompromised patients.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales , Neoplasias Pulmonares , Nocardiosis , Humanos , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Absceso/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Nocardiosis/diagnóstico por imagen , Glándulas Suprarrenales/patología , Estudios RetrospectivosRESUMEN
Objectives: Pulmonary nocardiosis is a rare opportunistic infection that is often encountered in immunocompromised patients, in particular those with the HIV infection and in solid organ transplant recipients. As the number of immunocompromised patients increase, the number of patients with pulmonary nocardiosis is also expected to increase. This study aimed to analyse both the chest high resolution computed tomography (HRCT) findings of patients with confirmed pulmonary nocardiosis and review the imaging features of pulmonary nocardiosis in the literature. Methods: This retrospective study was conducted at The Royal Hospital, Muscat, Oman, to identify patients with a diagnosis of pulmonary nocardiosis between January 2006 and January 2019. Accordingly, nine patients with pulmonary nocardiosis were identified, but three patients were excluded as no chest HRCT images were available. Patient clinical presentation was recorded and chest HRCT images were retrospectively reviewed. Results: A total of six patients were enrolled in this study. All were male and with a mean age of 41 ± 11 years. Three patients were immunocompromised, two of whom had undergone a renal transplant. The main HRCT findings were cavitary nodules/masses, non-cavitary nodules/masses, septal thickening, centrilobular nodules, ground glass opacities, consolidation, pleural effusion, pleural thickening, enlarged lymph nodes and necrotic lymph nodes. Conclusion: Pulmonary nocardiosis shows various findings in a chest CT, the most common of which are pulmonary nodules and masses. Awareness of these findings can help radiologists with a diagnosis in the appropriate clinical settings.
Asunto(s)
Infecciones por VIH , Nocardiosis , Derrame Pleural , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Intracranial infections caused by Nocardia Farcinica are challenging to treat and potentially lethal because of the organism's tendency to resist antibiotics and high relapse rates. Such infections usually occur in immunocompromised patients who have predisposing factors. Nocardia brain abscesses carry a higher morbidity and mortality rate than other bacterial brain abscesses, with reported mortality rates of 55% (even up to 90% in cases of late diagnosis) in immunocompromised patients. An aggressive therapeutic approach is required and an early identification of the microorganism is paramount. Given the high microbial resistance, it is usually an infection with a low cure rate. We present the case of a patient with primary brain abscesses due to Nocardia Farcinica, successfully treated with intrathecal Amikacin administration through ventricular drain, in addition to surgical evacuation and intravenous antibiotic therapy. In this case, clinical and radiological improvement were observed once the intrathecal treatment was started. To our best knowledge, no cases of intraventricular use of Amikacin have been previously reported to treat this type of infection and we believe that it may be useful in properly selected patients.
Asunto(s)
Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Absceso Encefálico/tratamiento farmacológico , Encéfalo/microbiología , Nocardiosis/tratamiento farmacológico , Anciano , Amicacina/administración & dosificación , Antibacterianos/administración & dosificación , Encéfalo/diagnóstico por imagen , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/microbiología , Humanos , Infusiones Intraventriculares , Imagen por Resonancia Magnética , Masculino , Nocardia , Nocardiosis/complicaciones , Nocardiosis/diagnóstico por imagen , Resultado del TratamientoRESUMEN
RATIONALE: Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. PATIENT CONCERNS: A 64-year-old man was diagnosed with empyema, 4âdays following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. DIAGNOSES: N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. INTERVENTIONS: The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. OUTCOMES: Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. LESSONS: Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.
Asunto(s)
Adenocarcinoma , Absceso Encefálico/diagnóstico , Neoplasias del Colon , Empiema/diagnóstico , Nocardiosis/diagnóstico , Nocardia/aislamiento & purificación , Antiinfecciosos/uso terapéutico , Absceso Encefálico/complicaciones , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Diagnóstico Diferencial , Empiema/complicaciones , Empiema/diagnóstico por imagen , Empiema/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Nocardiosis/complicaciones , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Nocardia species are opportunistic bacteria that are frequently contagious by inhalation. Recently, Nocardia abscessus has been described as a different species. We report a 54-year-old male who presented with acute pleuritic chest pain, mimicking pulmonary thromboembolism on the 5th day of discharge from the hospital. The patient was receiving immunosuppressive therapy for newly diagnosed atypical anti-glomerular basement membrane disease. Thorax computed tomography revealed a 17x19 mm soft tissue lesion in the lateral segment of the middle lobe of the right lung. After further examinations, a biopsy decision was made and Nocardia abscessus was isolated in the aerobic culture of the aspiration material.
Asunto(s)
Glomerulonefritis/complicaciones , Nocardiosis/diagnóstico , Embolia Pulmonar/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Nocardia/aislamiento & purificación , Nocardiosis/diagnóstico por imagen , Nocardiosis/microbiología , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A 47-year-old man was referred for ongoing workup of an enlarging lung mass. Extensive workup of the mass had been unrevealing for several months until cultures grew Nocardia beijingensis He was successfully treated with trimethoprim/sulfamethoxazole and then doxycycline with near-complete resolution of the mass on follow-up. This case presents a rare species of N. beijingensis It highlights the importance of considering nocardiosis in immunocompetent adults and the challenge in initiating targeted treatment due to delayed culture results.
Asunto(s)
Absceso/diagnóstico por imagen , Mediastinitis/diagnóstico por imagen , Nocardiosis/diagnóstico por imagen , Nocardia , Neumonía Bacteriana/diagnóstico por imagen , Absceso/complicaciones , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Biopsia , Biopsia con Aguja Gruesa , Sedimentación Sanguínea , Broncoscopía , Proteína C-Reactiva , Técnicas de Cultivo , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiología , Humanos , Inmunocompetencia , Masculino , Enfermedades del Mediastino/diagnóstico , Enfermedades del Mediastino/etiología , Mediastinitis/complicaciones , Mediastinitis/tratamiento farmacológico , Persona de Mediana Edad , Nocardiosis/complicaciones , Nocardiosis/tratamiento farmacológico , Nocardiosis/patología , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/patología , Tomografía de Emisión de Positrones , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. METHODS: We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. RESULTS: It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. CONCLUSIONS: It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.
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Absceso/etiología , Glomerulonefritis/complicaciones , Glucocorticoides/efectos adversos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Nocardiosis/etiología , Absceso/tratamiento farmacológico , Anciano , Antibacterianos/uso terapéutico , Encéfalo/diagnóstico por imagen , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/etiología , Femenino , Glomerulonefritis/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Pulmón/diagnóstico por imagen , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico , Nocardiosis/diagnóstico por imagen , Sulfonamidas/uso terapéutico , Tomografía Computarizada por Rayos XAsunto(s)
Nocardiosis/diagnóstico por imagen , Nocardia asteroides , Tuberculosis Miliar/diagnóstico por imagen , Anciano , Encéfalo/diagnóstico por imagen , Edema Encefálico/diagnóstico por imagen , Coma/etiología , Fiebre/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Nocardiosis/microbiología , Tuberculosis Miliar/microbiologíaRESUMEN
Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.
Asunto(s)
Antibacterianos/uso terapéutico , Síndrome de Cauda Equina/microbiología , Cauda Equina/efectos de los fármacos , Dolor de la Región Lumbar/microbiología , Nocardiosis/microbiología , Paraplejía/microbiología , Adulto , Cauda Equina/diagnóstico por imagen , Cauda Equina/microbiología , Cauda Equina/cirugía , Síndrome de Cauda Equina/diagnóstico por imagen , Síndrome de Cauda Equina/tratamiento farmacológico , Síndrome de Cauda Equina/cirugía , Descompresión Quirúrgica/métodos , Humanos , Laminectomía/métodos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor de la Región Lumbar/cirugía , Imagen por Resonancia Magnética , Masculino , Meropenem/uso terapéutico , Nocardia/efectos de los fármacos , Nocardia/crecimiento & desarrollo , Nocardia/patogenicidad , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Nocardiosis/cirugía , Paraplejía/diagnóstico por imagen , Paraplejía/tratamiento farmacológico , Paraplejía/cirugía , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Intracranial peripherally enhancing lesions in immunosuppressed solid organ transplant recipients represent a unique diagnostic and management dilemma due to the vast array of differentials that demand consideration. Diagnosis of the underlying pathology is often guided by the use of magnetic resonance imaging (MRI). We present the first published case series of three cardiac transplant recipients with significantly atypical neuroradiological findings contrary to the tenets of contemporary literature. Our rare case series consists of: (1) A sterile Mycobacterium pyogenic abscess mimicking glioblastoma multiforme due to an immunosuppressed state (2) Epstein Barr Virus encephalitis masquerading as Central Nervous System Post-Transplant Lymphoproliferative Disorder (3) An unusual case of partially treated disseminated Nocardiosis warning of the need to consider the immunosuppressed state and partial treatment response obfuscating classical MRI appearances. We utilise these unprecedented cases as the basis of a literature review to understand the pathophysiology behind the peculiar imaging findings in this rarefied cohort of transplant recipients, and rationalise why the MRI findings in each instance contradicts the accepted imaging patterns. In the setting of potential unreliability of neuroradiology in this immunosuppressed unique subgroup, we hope to impart to clinicians that definitive diagnosis obtained by emergent neurosurgical intervention may be necessary to accurately and expediently guide further medical management.
Asunto(s)
Encefalitis Viral/diagnóstico por imagen , Infecciones por Virus de Epstein-Barr/diagnóstico por imagen , Trasplante de Corazón/efectos adversos , Trastornos Linfoproliferativos/diagnóstico por imagen , Nocardiosis/diagnóstico por imagen , Receptores de Trasplantes , Anciano , Encefalitis Viral/inmunología , Infecciones por Virus de Epstein-Barr/inmunología , Trasplante de Corazón/tendencias , Humanos , Huésped Inmunocomprometido/inmunología , Trastornos Linfoproliferativos/inmunología , Imagen por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Nocardiosis/inmunologíaAsunto(s)
Huésped Inmunocomprometido , Nocardiosis/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Líquido del Lavado Bronquioalveolar/microbiología , Resultado Fatal , Femenino , Humanos , Nocardia/genética , Nocardiosis/tratamiento farmacológico , ARN Ribosómico 16S/genética , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Nocardia ignorata, which was first described in 2001, is a rare human pathogen. We report a case of pulmonary nocardiosis caused by this bacterium in a 55-year-old man from Iran. The patient, a gardener, had frequent exposure to soil and may have acquired the infection from that source.
Asunto(s)
Nocardiosis/diagnóstico , Nocardia/aislamiento & purificación , Microbiología del Suelo , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Humanos , Imipenem/administración & dosificación , Imipenem/uso terapéutico , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Nocardiosis is an uncommon infection caused by ubiquitous environmental aerobic gram-positive filamentous bacteria, present in soil and water. Skin and lungs are usually the main targets of localized infections. Rarely, disseminated forms can occur in immunocompromised individuals. A 63-year-old man with a history of late-onset asthma and nasal and sinus polyposis treated with oral low-dose corticosteroid regimen presented with fever, headache, myalgia, skin erythematous plaques, and pustules. Brain MRI revealed multiple abscesses and pachymeningitis. F-FDG PET/CT was performed to assess the extent of the infection. Cutaneous samples and sputum culture isolated Nocardia brasiliensis, confirming diagnosis of disseminated nocardiosis.