Disseminated nocardiosis masquerading as metastatic malignancy

Arjun, Rajalakshmi; Padmanabhan, Arjun; Attunuru, Bhanu Prakash Reddy; Gupta, Prerna

doi:10.4103/0970-2113.184920

Cited by 18 publications

(14 citation statements)

References 11 publications

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“…Although Aspergillus nodules are typically rounded, they can appear speculated which is a common appearance of carcinoma 131 . Aspergillus nodules can also mimic rheumatoid arthritis and bacterial infections such as Mycobacterium tuberculosis and non‐tuberculous mycobacterial infections, and Nocardia 132 and actinomycosis 7 . Sarcoidosis of the liver and spleen may mimic fungal hepatosplenic microabscesses 133 .…”

Section: Mimickers Of Breakthrough Invasive Fungal Infectionsmentioning

confidence: 99%

Breakthrough invasive fungal infections: Who is at risk?

Jenks

Cornely

Chen

et al. 2020

Mycoses

128

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The epidemiology of invasive fungal infections (IFIs) in immunocompromised individuals has changed over the last few decades, partially due to the increased use of antifungal agents to prevent IFIs. Although this strategy has resulted in an overall reduction in IFIs, a subset of patients develop breakthrough IFIs with substantial morbidity and mortality in this population. Here, we review the most significant risk factors for breakthrough IFIs in haematology patients, solid organ transplant recipients, and patients in the intensive care unit, focusing particularly on host factors, and highlight areas that require future investigation.

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Section: Mimickers Of Breakthrough Invasive Fungal Infectionsmentioning

confidence: 99%

Breakthrough invasive fungal infections: Who is at risk?

Jenks

Cornely

Chen

et al. 2020

Mycoses

128

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“…The fact that adrenal carcinoma is difficult to distinguish from abscesses on imaging [ 15 ] and that there were findings in the liver and bone on PET-CT may have accounted for the patient's listeriosis being a great mimicker of malignancy. Actinomycosis, nocardiosis, and mycosis have been reported to form foci reminiscent of malignancy, but all of these diseases are chronic infections [ 18 – 21 ]. We found only one report of multiple liver abscesses in an asymptomatic patient [ 22 ], but most listeriosis patients have symptoms such as fever, and follow an acute course.…”

Section: Discussionmentioning

confidence: 99%

Listeria monocytogenes bacteremia mimicking the systemic metastasis of adrenal cancer: a case report

et al. 2022

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Background Listeria monocytogenes is a causative agent of food poisoning and is also known to cause invasive diseases, such as bacteremia, meningitis, and encephalitis, in neonates, elderly and immunocompromised patients. However, the clinical course of a multi-organ disseminated disease secondary to bacteremia has been rarely reported. Case presentation A 76-year-old woman undergoing immunosuppressive therapy for rheumatoid arthritis presented to our outpatient clinic with a chief complaint of weight loss. Computed tomography showed a left adrenal mass, enlarged lymph nodes, and multiple intrahepatic nodules. Positron emission tomography demonstrated accumulation of fluorodeoxyglucose F18 in the adrenal mass, lymph nodes, hepatic nodules, and bones, leading to the suspicion of systemic metastasis of adrenal cancer. She subsequently developed a fever. Blood culture results led to the diagnosis of Listeria monocytogenes bacteremia. Percutaneous needle biopsy of the adrenal lesion revealed no malignant findings. After extended treatment with antimicrobial agents, the fever resolved, along with the disappearance of the systemic lesions. Conclusions This case shows that listeriosis can lead to lesions in the adrenal gland, which can exhibit clinical presentation that is difficult to differentiate from malignancy on imaging studies.

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“…Disseminated nocardiosis is defined as involvement of two noncontiguous sites that may or may not include a pulmonary focus. 11 The diagnosis of Nocardia is difficult and time-consuming and comprises isolation of Nocardia species from blood, urine, airwaysamples, and biopsies and it can take from a couple of days to weeks to confirm the suspicion. 10 In our patient, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be nocardiosis.…”

Section: Discussionmentioning

confidence: 99%

“…Hematogenous dissemination spreads particularly to the nervous system, skeletal, and soft tissue structures. Disseminated nocardiosis is defined as involvement of two noncontiguous sites that may or may not include a pulmonary focus 11 10 .…”

Section: Discussionmentioning

confidence: 99%

Nocardiosis in a patient with pemphigus foliaceus treated with rituximab

Yigit

Balta

Yiğit

et al. 2020

Dermatologic Therapy

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Rituximab is a chimeric human/murine monoclonal anti‐CD20 antibody. This agent is an effective therapeutic option in severe types of pemphigus. However, rituximab may cause opportunistic infections if used in immunosuppressed patients. We reported a case of diffuse Nocardia infection following rituximab treatment in pemphigus foliaceus. Rheumatoid arthritis protocol applied in our patient. Rituximab was used at a dose of 1000 mg every 2 weeks. Because the disease was not adequately controlled, rituximab treatment was administered six times every 15 days. One week after the sixth dose of the rituximab, she presented lassitude and multiple palpable masses in soft tissue of the upper extremity. Thereafter, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be disseminated nocardiosis. She was treated with linezolid and meropenem for 1 month; however, amikacin was added because the patient did not respond adequately to linezolid and meropenem therapy. The patient died of cardiac arrest because of her comorbidities. In this case, prolonged administration of rituximab therapy may have caused the development of nocardiosis. Therefore, all patients should have a sensible balance of risk and benefit, considering the use of rituximab.

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Disseminated nocardiosis masquerading as metastatic malignancy

Cited by 18 publications

References 11 publications

Breakthrough invasive fungal infections: Who is at risk?

Breakthrough invasive fungal infections: Who is at risk?

Listeria monocytogenes bacteremia mimicking the systemic metastasis of adrenal cancer: a case report

Nocardiosis in a patient with pemphigus foliaceus treated with rituximab

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