A case of acquired immunodeficiency syndrome patient with systemic disseminated Nocardia nova disease
10.3760/cma.j.cn114452-20241101-00602
- VernacularTitle:艾滋病患者合并全身播散性新诺卡菌病1例
- Author:
Li LIN
1
;
Lei ZHENG
1
;
Xiumei HU
1
Author Information
1. 南方医科大学南方医院检验科，广州 510510
- Publication Type:Journal Article
- Keywords:
Nocardia;
HIV Infections;
Nocardia nova;
Abscess
- From:
Chinese Journal of Laboratory Medicine
2025;48(9):1227-1230
- CountryChina
- Language:Chinese
-
Abstract:
A 51-year-old male presented to Nanfang Hospital, Southern Medical University, on September 30, 2024, with a 2-month history of cough and a 1-week history of fever. He had a medical history of human immunodeficiency virus (HIV) infection. The patient developed a paroxysmal cough in mid-July 2024, accompanied by a small amount of white phlegm and no fever. Despite treatment at a local community hospital, his symptoms persisted. After treatment at another local hospital on August 13, his cough improved. On September 23, the patient developed an unexplained fever. On September 25, a lump appeared below the left popliteal fossa and enlarged, prompting admission to our hospital. The patient presented with fever for one week and was found to have multiple abscesses in the lungs, buttocks, popliteal fossa, and other areas. Inflammatory markers (white blood cell count, neutrophil count, C-reactive protein, procalcitonin) were significantly elevated. Imaging and pathological findings were consistent with infection. Cultures grew Nocardia spp. Matria assisted laser desorption/ionization time of flight mass spectrometry suggested Nocardia veterana (confidence 80%), whereas 16S rRNA gene sequencing identified Nocardia nova. Both species belong to the Nocardia nova complex, which cannot be reliably differentiated by mass spectrometry alone. After admission, empirical antibacterial therapy was initiated with piperacillin-tazobactam and enrofloxacin, supplemented by antiretroviral therapy for HIV, Pneumocystis jirovecii pneumonia prophylaxis, gastric protection, nebulization, antihistamines, and correction of fluid and electrolyte imbalances. Local drainage of the left popliteal abscess was performed. On October 13, based on the pathogenic results from bronchoalveolar lavage fluid and pus, the diagnosis was disseminated nocardiosis. The antibiotic regimen was adjusted to trimethoprim-sulfamethoxazole and imipenem, after which the patient became afebrile. At discharge, the patient was afebrile with stable vital signs. The left popliteal abscess had decreased in size. Inflammatory markers showed a continuous downward trend. The patient was discharged on continued antibiotic therapy.
