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DISSEMINATED NOCARDIA INFECTION IN A PATIENT WITH DIABETES MELLITUS AND PROLONGED CORTICOSTEROID USE: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE
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Abstract
Background: Nocardia are aerobic, Gram-positive, branching filamentous, weakly acid-fast bacteria that primarily cause disease in immunocompromised patients but can also affect immunocompetent individuals. The infection may involve multiple organs, particularly the lungs and central nervous system, and carries a high mortality rate if diagnosis and treatment are delayed. Case Presentation: A 64-year-old male with a history of type 2 diabetes mellitus, prolonged corticosteroid use, and prior cerebrovascular accident was admitted with sepsis secondary to left thigh cellulitis, accompanied by dyspnea and altered consciousness. Chest CT and brain MRI revealed necrotizing pneumonia, multiple brain abscesses, and subdural empyema. Gram staining of pus demonstrated Gram-positive branching bacilli, and modified Kinyoun staining showed weak acid-fastness, consistent with Nocardia spp. The patient was treated with imipenem, amikacin, and trimethoprim–sulfamethoxazole. However, his condition did not improve, and due to poor prognosis, the family requested discharge after 13 days of treatment. Conclusion: This case illustrates the rapid progression and severity of disseminated Nocardia infection in an immunocompromised patient. Nocardia should be considered in cases of multi-organ infection unresponsive to standard treatment, with early Gram/Kinyoun staining and microbiological culture, alongside prompt initiation of prolonged combination antibiotic therapy to improve outcomes.
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Keywords
: Nocardia; Opportunistic infection; Brain abscess; Necrotizing pneumonia; Immunocompromised host.
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