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A Case Report of Disseminated Nocardiosis in a Patient With Hiv Infection: Concurrent Liver, Pulmonary, and Brain Involvements Publisher



Abbasian L1 ; Manshadi SAD2 ; Nezhad MH2 ; Masoumzadeh N2 ; Ghaderkhani S2 ; Keyvanfar A3 ; Tehrani S3
Authors
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Authors Affiliations
  1. 1. Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Infectious Disease and Tropical Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Archives of Clinical Infectious Diseases Published:2024


Abstract

Introduction: Disseminated nocardiosis is a rare but life-threatening infectious disease that occurs most often in immunocompromised individuals. This report presents a human immunodeficiency virus (HIV)-infected patient with disseminated nocardiosis in the liver, lung, and brain. Case Presentation: A 38-year-oldwomanwhohad recently been diagnosed with HIV infection complained of fever, abdominal pain, productive coughs, and occasional headaches from 2 months ago. Imaging findings of her abdomen and lungs displayed evidence of pyogenic liver abscess and lobar pneumonia with abscess formation, respectively. The patient underwent percutaneous liver abscess drainage and bronchoalveolar lavage (BAL). Using reverse transcription-polymerase chain reaction (RT-PCR), the genome of Nocardia farcinica was detected in the specimens obtained from both procedures. Besides, she had seizures during hospitalization. Based on cerebrospinal fluid (CSF) analysis, the specimen was positive for N. farcinica. Brain imaging also revealed evidence of multiple bacterial abscess formation. She was diagnosed with disseminated nocardiosis and treated with intravenous imipenem, trimethoprim/sulfamethoxazole, and amikacin, followed by appropriate oral agents. After a 6-month follow-up, the patient had no symptoms. Additionally, the lesions improved on brain imaging. Conclusions: Patients who are HIV-positive are particularly prone to opportunistic infections. Health care providers should consider all pathogens, even rare ones, like Nocardia spp., to establish a diagnosis if they’re present. Furthermore, in cases initially diagnosed with localized nocardiosis, other body organs should also be reviewed so that the disseminated form of the disease can be diagnosed and treated immediately. © 2024, Abbasian et al.