Case Report: Disseminated Nocardiosis Caused by Nocardia vulneris in a Patient With Macroglobulinemia

• Published in: Frontiers in public health Vol. 10; p. 866420
• Main Authors: Qiu, Fulan, Ma, Zhiyi, Zhong, Rongrong, Huang, Haonan, Wang, Yuehua, Liu, Hui
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 10.05.2022
• Subjects: 16S rRNA; Amikacin - therapeutic use; Anti-Infective Agents; disseminated nocardiosis; Humans; linezolid; Linezolid - therapeutic use; macroglobulinemia; Male; mass spectrometry; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections - diagnosis; Nocardia Infections - drug therapy; Nocardia vulneris; Public Health; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Waldenstrom Macroglobulinemia; 16S rRNA; Nocardia vulneris; linezolid; trimethoprim-sulfamethoxazole; minocycline; mass spectrometry; macroglobulinemia; disseminated nocardiosis
• ISSN: 2296-2565; 2296-2565
• DOI: 10.3389/fpubh.2022.866420

This report describes a case of disseminated nocardiosis, caused by , in a 61-year-old man with macroglobulinemia and presenting with repeated fever, cough, shortness of breath, and muscle pain. The isolated strain was resistant to ciprofloxacin, but susceptible to amikacin, gentamicin, tobramycin, linezolid, trimethoprim-sulfamethoxazole, amoxicillin/clavulanic, moxifloxacin, ceftriaxone, cefotaxim, and imipenem. The patient was started on combined meropenem and doxycycline treatment, followed by trimethoprim-sulfamethoxazole, which was subsequently switched to a combination treatment of linezolid, amikacin, and trimethoprim-sulfamethoxazole. The patient recovered, and his condition remained stable. Although infection by is rare, and it is easy to miss detection in clinical practice, clinicians should be aware of the possibility of this infection. In addition, the MIC value of the drug sensitivity test should be ascertained when there is a wide choice of medicines. The current case was treated successfully with linezolid, amikacin, and trimethoprim-sulfamethoxazole. In cases of disseminated nocardiosis, the patient should be treated with antimicrobial therapy for at least 12 months. Furthermore, bacteriological examination and antimicrobial susceptibility testing should be performed regularly.