Disseminated Nocardiosis that Mimicked Polypyomyositis: A Case Report

Abstract

Background: A concurrent underlying infection must be considered when immunocompromised patients present with multiple muscle abscesses. Disseminated nocardiosis is a rare infectious disorder that may disseminate to the muscle and other tissues, including the central nervous system. Here we describe the case and management of an immunocompromised patient who presented with disseminated nocardiosis and multiple muscle abscesses. In such cases, the by surgical drainage of muscle abscesses and subsequent early diagnosis and identification of the causative organism may facilitate appropriate treatment.

Case Presentation

A 70-year-old woman was admitted with general fatigue and left lower abdominal and hip pain. She had a 10-year history of treatment with azathioprine and prednisolone for AQP4-antibody-related neuromyelitis optica spectrum disorders. Although her vital signs were normal, laboratory data indicated a C-reactive protein concentration of 22.9mg/dL, and computed tomography revealed a coin-sized lesion in her right lung and abscesses in the left abdominal oblique and gluteal muscles. A blood culture was positive for multidrug-resistant Staphylococcus epidermidis. We surgically drained the multilocular abscesses and conducted a bacteriological evaluation, which revealed the presence of Nocardia spp. The patient recovered and was given a plan of sulfamethoxazole–trimethoprim therapy for 6 months.

Conclusions

Regardless of the positive result of blood culture consistent with multiple abscess formation, we should consider for disseminated nocardiosis in immunocompromised patients. To prevent central nervous infection and relapse, aggressive bacteriological evaluation and appropriate antibiotics therapy may be essential.