Infection and Drug Resistance (Oct 2021)

Membranous Nephropathy Complicated with Disseminated Nocardia farcinica Infection: A Case Report and Literature Review

  • Pan L,
  • Wang XH,
  • Meng FQ,
  • Su XM,
  • Li Y,
  • Xu MT,
  • Su FY,
  • Kong DL,
  • Wang W

Journal volume & issue
Vol. Volume 14
pp. 4157 – 4166

Abstract

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Lei Pan,1,2 Xu-Hao Wang,1 Fan-Qi Meng,1 Xin-Ming Su,1 Yue Li,1 Ming-Tao Xu,1 Feng-Yuan Su,3 De-Lei Kong,1 Wei Wang1 1Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, People’s Republic of China; 2Liaoning Provincial Centers for Disease Control and Prevention, Shenyang, People’s Republic of China; 3China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: De-Lei KongDepartment of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, People’s Republic of ChinaEmail [email protected]: Disseminated infection caused by Nocardia farcinica with primary nephrotic syndrome is exceedingly rare. A 66-year-old female visited the outpatient department due to fever and fatigue who had been diagnosed as membranous nephropathy and with a long-term prednisone and immunosuppressive therapy. After lung biopsy for many times, culture from space-occupying lesion of the right lung and species identification by mass spectrometry-based methods (MALDI-TOF) revealed Nocardia farcinica. By imaging examination, space-occupying lesions from the lungs, brain, abdominal cavity and kidney were found. After 2 weeks of meropenem intravenous and up to 6 months of trimethoprim-sulfamethoxazole (TMP-SMX) therapy, our patient has remained relapse-free at that time of writing. Disseminated infection caused by Nocardia farcinica is usually subacute with complex clinical manifestations. In addition, it can be easily confused with diseases such as tumor and mycobacterial infection, and lead to fatal consequences. Therefore, we hope that we can remind clinicians considering by discussing common features of disseminated Nocardia farcinica infection.Keywords: disseminated nocardiosis, fever, space-occupying lesions, brain abscess, renal insufficiency

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