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
Affiliations
Kazuya Nagasaki
Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan
Harumi Gomi
Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Japan; Office of Medical Education and Center for Infectious Diseases, School of Medicine, International University of Health and Welfare, Japan; Corresponding author at: 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
Haruhiko Ishioka
Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Japan
Shijima Taguchi
Department of Dermatology, Mito Kyodo General Hospital, University of Tsukuba, Japan
Norio Takayashiki
Department of Pathology, Mito Kyodo General Hospital, University of Tsukuba, Japan
Hiroyuki Kobayashi
Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan
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.
