Systemic Nocardia asteroides infection with endocardial involvement in a patient undergoing immunosuppressive therapy

Deutsche medizinische Wochenschrift
R NiehuesD Horstkotte

Abstract

A 62 year-old male patient developed malaise, unproductive cough and high temperature (39.5 degrees C) during immunosuppressive therapy with methylprednisolon and cyclosporin A six months after kidney transplantation for glomerulonephritis. Clinical examination revealed an endophthalmitis and chest X ray a left-sided lobar pulmonic infiltration. Computed tomography and magnetic resonance imaging examination performed because of recurrent petit-mal-convulsions demonstrated multiple intracranial infiltrations. Transoesophageal echocardiography revealed floating vegetations up to 8 mm in diameter predominantly attached to the aortic valve. A total of 39 consecutive blood cultures drawn during several days remained sterile. However, Nocardia asteroides (Biovar A1) was isolated from a small cutaneous tumor excised from the right thigh. After initiation of a specific antibiotic treatment with imipenem/cilastatin (each 1 g three times daily), and doxycyclin (100 mg twice daily), computed tomography and magnetic resonance imaging showed a reduction in size and number of the intracranial infiltrations. Neurological symptoms were progressive despite maximal anticonvulsant therapy. The patient died 83 days after hospital admission from an...Continue Reading

Citations

Feb 9, 2011·Der Pathologe·D TheegartenK-D Müller
Oct 3, 2009·Journal of Medical Microbiology·James S CargillNigel C Weightman
Aug 5, 2011·Survey of Ophthalmology·Margherita E Eschle-MeniconiThomas J Wolfensberger
Oct 15, 2018·BMJ Case Reports·Antonious Ziad Hazim, André Martin Mansoor
Aug 26, 1998·Medicine·D P KontoyiannisD C Hooper
Jun 29, 2001·Transplant Infectious Disease : an Official Journal of the Transplantation Society·J BisharaS Pitlik
Mar 17, 2021·Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy·Yoshihiko KiyasuShigemi Hitomi

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