The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Multiple Intramuscular Abscesses Caused by Nocardia abscessus in a Patient with Chronic Obstructive Lung Disease: Clinical Microbiology Considerations

만성 폐쇄성 폐질환으로 저용량 스테로이드 유지 중인 환자에게 발생한 Nocardia abscessus에 의한 다발성 근육 농양 1예

  • Jung-Ah Kim (Department of Laboratory Medicine, Soonchunhyang University Hospital Seoul) ;
  • Hyunjoo Dong (Department of Laboratory Medicine, Soonchunhyang University Hospital Seoul) ;
  • Eunjung Lee (Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital Seoul) ;
  • Jongtak Jung (Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital Seoul) ;
  • Yae Jee Baek (Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital Seoul) ;
  • Tae Hyong Kim (Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital Seoul) ;
  • Tae Youn Choi (Department of Laboratory Medicine, Soonchunhyang University Hospital Seoul)
  • 김정아 (순천향대학교 서울병원 진단검사의학과) ;
  • 동현주 (순천향대학교 서울병원 진단검사의학과) ;
  • 이은정 (순천향대학교 서울병원 감염내과) ;
  • 정종탁 (순천향대학교 서울병원 감염내과) ;
  • 백예지 (순천향대학교 서울병원 감염내과) ;
  • 김태형 (순천향대학교 서울병원 감염내과) ;
  • 최태윤 (순천향대학교 서울병원 진단검사의학과)
  • Received : 2023.07.31
  • Accepted : 2023.10.10
  • Published : 2024.02.01
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Abstract

Nocardiosis is uncommon. Immunocompromising conditions predispose individuals to pulmonary and disseminated nocardiosis of the brain, skin, and subcutaneous tissues. The most common pathogens are Nocardia cyriacigeorgica, Nocardia nova, and Nocardia farcinica. The speciation of Nocardia to determine antimicrobial susceptibility is difficult using traditional biochemical methods. Here, we report the case of a 73-year-old man with chronic obstructive lung disease who developed a rapidly progressing intramuscular abscess around the left hip and thigh. Within 3 days, the lesions progressed to an epidural abscess at the L4 to S1 level. Although he was treated with broad-spectrum antibiotics and extensive incision and drainage, he died of rapidly progressive respiratory failure. Nocardia abscessus (N. abscessus) was identified in pus samples using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). This case shows that the diagnosis of an intramuscular abscess caused by N. abscessus is challenging and that using MALDI-TOF MS may facilitate the diagnosis and ensure appropriate treatment.

Keywords

Acknowledgement

The authors thank the orthopedic surgeon, Sung-Woo Choi who performed incision and drainage despite the patient's critical condition, and the respiratory physician, Youngeun Jang who provided respiratory care to the patient after surgery.

References

  1. Galar A, Martin-Rabadan P, Marin M, et al. Revisiting nocardiosis at a tertiary care institution: any change in recent years? Int J Infect Dis 2021;102:446-454.
  2. Valdezate S, Garrido N, Carrasco G, et al. Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain. J Antimicrob Chemother 2017;72:754-761.
  3. Toyokawa M, Ohana N, Ueda A, et al. Identification and antimicrobial susceptibility profiles of Nocardia species clinically isolated in Japan. Sci Rep 2021;11:16742.
  4. Lopez VN, Ramos JM, Meseguer V, et al. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore) 2009;88:120-130.
  5. Berd D. Nocardia brasiliensis infection in the United States: a report of nine cases and a review of the literature. Am J Clin Pathol 1973;60:254-258.
  6. Noh JY, Cheong HJ, Heo JY, et al. Pulmonary and psoas muscle nocardiosis in a patient with lupus nephritis: a case report and review of the literature. Rheumatol Int 2011;31:929-936.
  7. Ukai Y, Fujimoto N, Fujii N, et al. Case of muscle abscess due to disseminated nocardiosis in a patient with autoimmune hemolytic anemia, and review of the published work. J Dermatol 2012;39:466-469.
  8. Kandasamy VV, Nagabandi A, Horowitz EA, Vivekanandan R. Multidrug-resistant Nocardia pseudobrasiliensis presenting as multiple muscle abscesses. BMJ Case Rep 2015;2015:bcr2014205262.
  9. 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.
  10. Restrepo A, Clark NM; Infectious Diseases Community of Practice of the American Society of Transplantation. Nocardia infections in solid organ transplantation: guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant 2019;33:e13509.