A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review

Abstract

Background Nocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients. Myasthenia gravis (MG) patients are potentially at risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement has not been reported in MG patients. Case presentation A 66-year-old man with MG who was receiving treatment with methylprednisolone and azathioprine was found to have a respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria verified by the culture of puncture fluid, and a diagnosis of disseminated nocardiosis was made. Except for left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed the previous relevant literature. According to the literature, this is the first report of disseminated nocardiosis with ocular involvement in an MG patient. Conclusions MG patients with immunosuppressant treatments are potentially at risk of a rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

Mild Pulmonary Nocardiosis Caused by <i>Nocardia terpenica</i> in an Immunocompetent Patient

“…Linezolid, which is able to penetrate the blood-brain barrier, is recommended for central nervous system infections. The drugs, doses, and course of treatment used vary widely from case to case (24)(25)(26). Patients should thus be treated individually according to the location and severity of their nocardial infection (27).…”