Fever of unknown origin revealing testicular nocardiosis: a case report and literature review.
Nocardia
Brain abscess
Disseminated nocardiosis
Epididymo-orchitis
Fever of unknown origin
Scrotal abscess
Testicular nocardiosis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
21 Jun 2024
21 Jun 2024
Historique:
received:
09
04
2024
accepted:
17
06
2024
medline:
22
6
2024
pubmed:
22
6
2024
entrez:
21
6
2024
Statut:
epublish
Résumé
Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis. We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient's condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis. To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.
Sections du résumé
BACKGROUND
BACKGROUND
Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis.
CASE PRESENTATION
METHODS
We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient's condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis.
CONCLUSIONS
CONCLUSIONS
To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.
Identifiants
pubmed: 38907186
doi: 10.1186/s12879-024-09521-8
pii: 10.1186/s12879-024-09521-8
doi:
Substances chimiques
Anti-Bacterial Agents
0
Trimethoprim, Sulfamethoxazole Drug Combination
8064-90-2
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
614Informations de copyright
© 2024. The Author(s).
Références
Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc. 2012;87(4):403–7.
Williams E, Jenney AW, Spelman DW. Nocardia bacteremia: a single-center retrospective review and a systematic review of the literature. Int J Infect Dis. 2020;92:197–207.
doi: 10.1016/j.ijid.2020.01.011
pubmed: 31978577
Steinbrink J, Leavens J, Kauffman CA, Miceli MH. Manifestations and outcomes of Nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients. Medicine. 2018;97(40):e12436.
doi: 10.1097/MD.0000000000012436
pubmed: 30290600
pmcid: 6200467
Haussaire D, Fournier PE, Djiguiba K, Moal V, Legris T, Purgus R, et al. Nocardiosis in the south of France over a 10-years period, 2004–2014. Int J Infect Dis. 2017;57:13–20.
doi: 10.1016/j.ijid.2017.01.005
pubmed: 28088585
Lerner P, Nocardiosis. Clin Infect Dis. 1996;22(6):891–903.
doi: 10.1093/clinids/22.6.891
pubmed: 8783685
Margalit I, Lebeaux D, Tishler O, Goldberg E, Bishara J, Yahav D, et al. How do I manage nocardiosis? Clin Microbiol Infect. 2021;27(4):550–8.
doi: 10.1016/j.cmi.2020.12.019
pubmed: 33418019
Duggal SD, Chugh TD, Nocardiosis. A neglected disease. Med Princ Pract. 2020;29(6):514–23.
doi: 10.1159/000508717
pubmed: 32422637
pmcid: 7768126
Meena DS, Kumar D, Bohra GK, Midha N, Garg MK. Clinical characteristics and treatment outcome of central nervous system nocardiosis: a systematic review of reported cases. Med Princ Pract. 2022;31(4):333–41.
doi: 10.1159/000525509
pubmed: 35700710
pmcid: 9485982
Sakamaki I, Ueno A, Kawasuji H, Miyajima Y, Kawago K, Hishikawa Y, et al. Prostate abscess caused by Nocardia Farcina. IDCases. 2019;18:e00640.
doi: 10.1016/j.idcr.2019.e00640
pubmed: 31692509
pmcid: 6804916
Mahvi TA. Disseminated nocardiosis caused by Nocardia brasiliensis: first case report in the United States. Arch Dermatol. 1964;89(3):426–31.
doi: 10.1001/archderm.1964.01590270112025
pubmed: 14096366
Young LS, Armstrong D, Blevins A. Nocardia asteroides infection complicating neoplastic disease. Am J Med. 1971;50(3):356–67.
doi: 10.1016/0002-9343(71)90224-5
pubmed: 4928780
Diamond RD, Bennett JE. Disseminated Nocardia brasiliensis infection. Arch Intern Med. 1973;131(5):735–6.
doi: 10.1001/archinte.1973.00320110119019
pubmed: 4701385
Geelhoed GW, Myers GH. Nocardiosis of the testis. J Urol. 1974;111(6):791–3.
doi: 10.1016/S0022-5347(17)60077-6
pubmed: 4208609
Strong D, Hodges C. Disseminated nocardiosis presenting as testicular abscess. Urology. 1976;7(1):57–9.
doi: 10.1016/0090-4295(76)90562-8
pubmed: 1108346
Wheeler JS, Culkin DJ, O’Connell J, Winters G. Nocardia epididymo-orchitis in an immunosuppressed patient. J Urol. 1986;136(6):1314–5.
doi: 10.1016/S0022-5347(17)45327-4
pubmed: 3773115
Parmentier L, Salmon-Ceron D, Boiron P, Paul G, Guez T, Dupont B, et al. Pneumopathy and kidney abscess due to Nocardia farcinica in an HIV-infected patient. AIDS. 1992;6(8):891–3.
doi: 10.1097/00002030-199208000-00026
pubmed: 1418795
Shohaib S. Nocardial psoas and perinephric abscess in a renal transplant treated by surgery and antibiotics. Nephrol Dial Transpl. 1994;9(8):1209–10.
doi: 10.1093/ndt/9.8.1209
López E, Ferrero M, Lumbreras C, Gimeno C, González-Pinto I, Palengue E. A case of testicular nocardiosis and literature review. Eur J Clin Microbiol Infect Dis. 1994;13(4):310–3.
doi: 10.1007/BF01974607
pubmed: 8070436
Diego Miralles G. Disseminated Nocardia farcinica infection in an AIDS patient. Eur J Clin Microbiol Infect Dis. 1994;13(6):497–500.
doi: 10.1007/BF01974641
Salahuddin F, Sen P, Chechko S. Urinary tract infection with an unusual pathogen Nocardia asteroides. J Urol. 1996;155(2):654–5.
doi: 10.1016/S0022-5347(01)66487-5
pubmed: 8558694
Frangié C, Morel D, Sassoust G, Pariente JL, Grenier N, Lacut JY, et al. A rare infection in a renal transplant recipient. Nephrol Dial Transpl. 2001;16(6):1285–7.
doi: 10.1093/ndt/16.6.1285
Benes J, Viechova J, Picha D, Horova B, Zatloukal P. Disseminated Nocardia asteroides infection in an immunocompetent woman following an arm injury. Infection. 2003;31(2):112–4.
doi: 10.1007/s15010-003-3073-x
pubmed: 12682817
Qu L, Strollo DC, Bond G, Kusne S. Nocardia prostatitis in a small intestine transplant recipient. Transpl Infect Dis. 2003;5(2):94–7.
doi: 10.1034/j.1399-3062.2003.00022.x
pubmed: 12974790
Routh JC, Lischer GH, Leibovich BC. Epididymo-orchitis and testicular abscess due to Nocardia asteroides complex. Urology. 2005;65(3):591.
doi: 10.1016/j.urology.2004.09.008
pubmed: 15780388
Severo CB, Oliveira FDM, Cunha L, Cantarelli V, Severo LC. Nocardia farcinica: diagnosis by thyroid abscess culture. Rev Inst Med Trop Sao Paulo. 2005;47(6):355–8.
doi: 10.1590/S0036-46652005000600009
pubmed: 16553327
Kepkep K, TunCay YA, YIgItbasI R. Nocardial tubo-ovarian abscess in a pregnant woman: a rare case report. Aust N Z J Obstet Gynaecol. 2006;46(4):363–5.
doi: 10.1111/j.1479-828X.2006.00607.x
pubmed: 16866802
Gallo A, Bettoni G, Trezzi G, Lalinga V, Frigerio L. Primary vulvar nocardiosis. Obstet Gynecol. 2006;108(3):728–30.
doi: 10.1097/01.AOG.0000188068.10174.90
pubmed: 17018480
Dehghani M, Davarpanah MA. Epididymo-orchitis and central nervous system nocardiosis in a bone marrow transplant recipient for acute lymphoblastic leukemia. Exp Clin Transpl. 2009;7(4):264–6.
Tanioka K, Tabu H, Uemura K, Matsumoto R, Takahashi R, Nagao M, et al. Disseminated Nocardia farcinica infection in a patient with myasthenia gravis successfully treated by linezolid: a case report and literature review. J Infect Chemoter. 2012;18(3):390–4.
doi: 10.1007/s10156-011-0315-1
De Montmollin E, Corcos O, Noussair L, Leflon-Guibout V, Belmatoug N, Joly F, et al. Retroperitoneal abscesses due to Nocardia farcinica: report of two cases in patients with malnutrition. Infection. 2012;40(1):93–6.
doi: 10.1007/s15010-011-0176-7
pubmed: 21861123
Yamaguchi H, Sekimoto E, Shirakami A, Shibata H, Ozaki S, Shigekiyo T, et al. Testicular nocardiosis accompanied by cutaneous lesions in an immunocompetent man. Intern Med. 2013;52(1):129–33.
doi: 10.2169/internalmedicine.52.7301
pubmed: 23291688
Poisnel E, Roseau JB, Landais C, Rodriguez-Nava V, Bussy E, Gaillard T. Nocardia veterana: disseminated infection with urinary tract infection. Braz J Infect Dis. 2015;19(2):216–9.
doi: 10.1016/j.bjid.2014.11.003
pubmed: 25636185
pmcid: 9425234
Eren E, Ulu-Kilic A, Atalay A, Demiraslan H, Parkan O, Koc N. Report of an immunocompetent case with disseminated infection due to Nocardia otitidiscaviarum: identification by 16S rRNA gene sequencing. Infez Med. 2016;24(1):71–6.
pubmed: 27031902
Scorey H, Daniel S. Nocardia farcinica bacteraemia presenting as a prostate abscess. IDCases. 2016;5:24–6.
doi: 10.1016/j.idcr.2016.06.001
pubmed: 27419070
pmcid: 4933029
Bonifaz A, Espinosa-Díaz S, Argáez J, Hernández-Castro R, Xicohtencatl-Cortes J, Tirado-Sánchez A. Actinomycetoma due to Nocardia brasiliensis with extension to the ovaries. Eur J Obstet Gynecol Reprod Biol. 2017;211:224–5.
doi: 10.1016/j.ejogrb.2017.02.023
pubmed: 28259373
Biswas Roy S, Ross MD, Patil PD, Trepeta R, Bremner RM, Panchabhai TS. Primary Nocardia infection causing a fluorodeoxyglucose-avid right renal Mass in a redo lung transplant recipient. Case Rep Transpl. 2018;2018:1–5.
Marques C, Ribeiro M, Bonccoraglio MT, Braga J, Pereira AF, Ogando A. Disseminated nocardiosis: the complexity of the diagnosis. J Med Cases. 2021;12(5):205–8.
doi: 10.14740/jmc3673
pubmed: 34434458
pmcid: 8383530
Pan L, Wang XH, Meng FQ, Su XM, Li Y, Xu MT, et al. Membranous nephropathy complicated with disseminated Nocardia farcinica infection: a case report and literature review. Infect Drug Resist. 2021;14:4157–66.
doi: 10.2147/IDR.S331737
pubmed: 34675560
pmcid: 8517639
Shen TA, Hsu YH, Ding DC. Xanthogranulomatous inflammation caused by K. pneumonia and nocardiosis mimicking a uterine tumor and invading the ureter and colon: a case report and review of the literature. Taiwan J Obstet Gynecol. 2022;61(5):889–95.
doi: 10.1016/j.tjog.2021.12.006
pubmed: 36088063
Torres OH, Domingo P, Pericas R, Boiron P, Montiel JA, Vázquez G. Infection caused by Nocardia farcinica: case report and review. Eur J Clin Microbiol Infect Dis. 2000;19(3):205–12.
doi: 10.1007/s100960050460
pubmed: 10795594
Van Luin A, Manson WL, Van Der Molen L, Van Der Heide JJH, Van Son WJ. An intrarenal abscess as presenting symptom of an infection with Nocardia farcinica in a patient after renal transplantation. Transpl Infect Dis. 2008;10(3):214–7.
doi: 10.1111/j.1399-3062.2007.00275.x
pubmed: 17727619