Mixed infection of Nocardia farcinica and Nocardia cyriacigeorgica in an immunocompromised patient: A case report

Abstract

Rationale: Nocardia is a soil saprophyte, which can cause disseminated infection in immunocompromised patients. Early diagnosis and treatment can greatly improve prognosis. Patient concern: A 26-year-old male presented with repeated episodes of fever, cough and breathlessness for 3 months. Diagnosis: Mixed infection of Nocardia (N.) farcinica and N. cyriacigeorgica with diabetes and Cushing’s syndrome. Interventions: N. cyriacigeorgica was isolated from empyema fluid and N. farcinica from blood. Based on antimicrobial susceptibility, he was treated with imipenem, cotrimoxazole and amikacin. Outcome: Patient expired due to infection and delayed diagnosis. Lesson: Several cases of infection due to N. farcinica or N. cyriacigeorgica have been reported. But mixed infection caused by these two species is rare. Pulmonary and disseminated nocardiosis is associated with high mortality, especially in immunocompromised hosts. So early diagnosis and prompt treatment is needed.

Keywords

• nocardia cyriacigeorgica
• nocardia farcinica
• matrixassisted laser desorption ionization time-of-flight mass spectrometry