Challenges in treatment of disseminated nocardiosis in an elderly patient with renal failure on corticosteroids: a case report

Kazuya Nagasaki; Harumi Gomi; Haruhiko Ishioka; Shijima Taguchi; Norio Takayashiki; Hiroyuki Kobayashi

doi:10.1016/j.idcr.2020.e00755

Challenges in treatment of disseminated nocardiosis in an elderly patient with renal failure on corticosteroids: a case report

IDCases. 2020 Apr 9:20:e00755. doi: 10.1016/j.idcr.2020.e00755. eCollection 2020.

Authors

Kazuya Nagasaki¹, Harumi Gomi^{2

3}, Haruhiko Ishioka², Shijima Taguchi⁴, Norio Takayashiki⁵, Hiroyuki Kobayashi¹

Affiliations

¹ Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan.
² Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Japan.
³ Office of Medical Education and Center for Infectious Diseases, School of Medicine, International University of Health and Welfare, Japan.
⁴ Department of Dermatology, Mito Kyodo General Hospital, University of Tsukuba, Japan.
⁵ Department of Pathology, Mito Kyodo General Hospital, University of Tsukuba, Japan.

Abstract

We report the case of a 71-year-old Japanese man with a history of chronic kidney disease and sarcoidosis receiving chronic corticosteroids who presented with disseminated Nocardia brasiliensis infection. He initially showed improvement with empiric antimicrobial therapy including trimethoprim-sulfamethoxazole. However, he deteriorated after modifying the empiric regimen due to complicated hyperkalemia and ultimately died. In general, elderly patients have decreased renal function. Standard therapy for nocardiosis with trimethoprim-sulfamethoxazole may not be used for a prolonged period of time. This case emphasizes the challenges and importance of prudent selection of empiric antimicrobial therapy for disseminated nocardiosis in elderly patients with underlying kidney disease.

Keywords: Nocardia brasiliensis; disseminated nocardiosis; linezolid; trimethoprim-sulfamethoxazole.

Publication types

Case Reports