Nocardia nova as the Causative Agent in Spondylodiscitis and Psoas Abscess

Abstract

We describe here the first case of Nocardia nova spondylodiscitis accompanied by a psoas abscess due to spreading from pulmonary nocardiosis. Nocardia was cultured from all affected sites. After 1 year of an appropriate antimicrobial therapy and a surgical drainage of the abscess that was required, the patient's clinical condition had improved. CASE REPORTIn 2001, a 27-year-old female was admitted to the Department of Nephrology-Transplantation Section because of abdominal and back pain, accompanied by a high-grade fever. In 1991, she was diagnosed with end-stage renal disease due to focal segmental glomerular sclerosis. She was treated for 1 year using hemodialysis, and in 1992 she received her first renal cadaveric transplant, but it was rejected 1 year later. In March 2000, she received a second renal transplant. Because of several episodes of acute rejection despite treatment with prednisone, cyclosporine, and mycophenolate mofetil, the hemodialysis was restarted 6 months later, and the graft was removed. After this surgery, she developed Staphylococcus epidermidis septicemia and an Aspergillus fumigatus pulmonary infection. Immunosuppressive therapy was discontinued and, despite antimicrobial therapy directed against these two infections, 1 month later (October 2000) she developed a second pulmonary infection with high fever, nonproductive cough, and dyspnea. A chest X-ray and computed tomography showed multiple nodules without cavitations.Bronchial aspirate, bronchoalveolar lavage fluid, and a lung biopsy analyses were performed. Direct Gram-stained smears of all specimens showed branched gram-positive rods, and a modified acid-fast stain was positive. Cultures of all specimens grew a Nocardia species. Growth on blood agar and chocolate plates occurred within 3 days of inoculation and showed white opaque and dry colonies, which became chalky and orange with prolonged incubation. The presumptive diagnosis as Nocardia nova complex was obtained from a combination of growth characteristics, aerial hypha production, lysozyme resistance, and a drug susceptibility test performed by the disk diffusion method (5, 20).The patient became afebrile 7 days after the start of a 6-week treatment with intravenous antibiotics, including amikacin (500 mg once daily), imipenem (500 mg three times daily), and trimethoprim-sulfamethoxazole (80 mg of trimethoprim and 400 mg of sulfamethoxazole; two vials of 5 ml administered twice daily), followed by 2 months with the latter two antibiotics alone. Her clinical condition improved rapidly. She was discharged from the hospital and was treated by hemodialysis three times a week.In August 2001, she complained of abdominal and back pain and progressive fever. Her temperature was above 39°C with a normal physical examination except that her back was painful, with the pain was exacerbated when she moved. The spine was tender to palpation at the level of L4-L5 without neurological signs.The laboratory evaluation showed an elevated C-reactive protein (CRP) level of 115 mg/liter and leukoc...

Spinal nocardiosis: A rare tuberculosis mimic in an HIV infected patient

“…Dissemination can occur to any organ but CNS involvement, usually in the form of cerebral abscesses, is most common [1] , [3] , [8] , [9] . In contrast, primary spinal nocardiosis is exceedingly rare with less than thirty cases reported in the literature up to 2020 [2] , [6] , [10] , [11] .…”

“…Low awareness, poor access to diagnostic tests and the slow growing nature of nocardia often leads to a delay in diagnosis and treatment initiation [2] , [6] , [10] , [12] . Nocardiosis is difficult to diagnose as symptoms are non-specific with no pathognomonic clinical features.…”

“…Treatment duration remains uncertain and varies according to host immunity and extent of the disease. Combination therapy is indicated in severe disease [4] , [10] , [11] , [14] .…”

rimary Nocardial Vertebra Osteomyelitis in an Immunocompetent Patient

“…Hamdad ve ark. (5) 'nın sunduğu bir olguda, BT rehberliğinde yapılan lomber vertebra iğne biyopsisinde alınan materyalin Gram boyamasında hiçbir mikroorganizma görülmemiş, kanlı agar ve çikolatalı agar besiyerlerinde 10 günlük inkübasyonuna rağmen üreme olmamıştır. Hasta pulmoner nokardiyoz nedeniyle takip edilmekte olduğundan materyal kan kültürüne ekilerek BacT/Alert kan kültürü sisteminde dört hafta süre ile inkübe edilmiş ve örnekte Nocardia spp.…”

“…Hamdad ve ark. (5) 'nın sunduğu olguda ise hastada pulmoner tutuluma sekonder lomber vertebra osteomyelitine eşlik eden psoas apsesi bulunmaktadır. Hasta psoas apsesinin cerrahi drenajı ve TMP-SMZ, amikasin ve imipenem kombinasyon tedavisi ile sekelsiz olarak iyileşmiştir.…”