Patients with rheumatic immune diseases on immunosuppressants who died of Nocardia farcinica infection - case report

Abstract

Background: Nocardiosis is a rare suppurative infectious disease caused by Nocardia, a gram-positive filamentous bacterium that is widely distributed in air, water, soil and other media. It usually occurs in patients treated with immunosuppressants but can also occur in healthy people. The aim of this study was to describe the course of two patients with rheumatic immune diseases who died of pneumonia and brain, renal, liver abscesses and sepsis caused by Nocardia farcinica infection. Case presentation: A 74-year-old retired male, diagnosed with dermatomyositis (DM), and a 54-year-old female farmer, diagnosed with systemic lupus erythematosus (SLE), both taking glucocorticoids and immunosuppressants, suffered from pneumonia and brain, renal, and liver abscesses and sepsis caused by Nocardia farcinica. Their medical treatment processes were very complicated, and they underwent multiple examinations and multidisciplinary consultations. They were finally diagnosed with pneumonia, brain, renal, and liver abscesses and sepsis caused by Nocardia farcinica infection through blood, sputum and bronchoalveolar lavage fluid culture. They were treated with antibacterial drugs, but the course was insufficient because of economic reasons, and eventually, they died. Conclusions: Nocardia farcinica is a rare but possible cause of pneumonia or brain, renal, liver abscesses or sepsis inpatients with rheumatic immune diseases. If infection is not ruled out in the lungs or other organs, it is necessary to actively utilise a variety of pathogenic tests, including blood culture. Once patients with immunosuppressive agents get pneumonia, brain abscesses, renal abscesses, liver abscesses or sepsis caused by Nocardia farcinica, they are in a critical condition and easily die.