Nocardiosis in a Patient with Hepatocellular Carcinoma

Abstract

The immunocompromised patients, due to various clinical conditions, are under the risk of development of opportunistic infections. Forty-nine years old male patient complaining from anorexia, fatique and abdominal tension admitted to the internal medicine clinic of our hospital and was diagnosed as hepatocellular carcinoma histopathologically. Nocardia brasiliensis was isolated and identified from ascites fluid during microbiological screening. Antibiotic susceptibility testing results of the isolate, obtained by both disk diffusion and E-test method, were evaluated together. Although there is no standardised approach in the evaluation of susceptibility test results, the large inhibition zones produced by trimethoprim-sulfamethoxazole (TMPSXT), ciprofloxacin, amoxicillin-clavulanic acid, doxycycline and aminoglycosides were noted. In addition, relatively low MIC values were obtained by E-test with above mentioned antibiotics. Previous treatment regimen was discontinued and TMP-SXT monotherapy was started promptly. One week later, after the administration of TMP-SXT, repeated culture was negative. We conclude that both clinicians and laboratory physicians need to be cautious because of the opportunistic nature of Nocardia species especially in patients under high risk.

Keywords

• Nocardia brasiliensis
• Ascites fluid
• Hepatocellular carcinoma