Challenges in treatment of disseminated nocardiosis in an elderly patient with renal failure on corticosteroids: a case report. (2020)

• Record Type: Journal Article
• Authors: Nagasaki, Kazuya; Gomi, Harumi; Ishioka, Haruhiko; Taguchi, Shijima; Takayashiki, Norio; Kobayashi, Hiroyuki
• Is Part Of: IDCases. Volume 20(2020)
• Publication Date: 2020
• Subjects: disseminated nocardiosis -- Nocardia brasiliensis -- trimethoprim-sulfamethoxazole -- linezolid; Communicable diseases -- Periodicals; Communicable Diseases -- Case Reports; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1016/j.idcr.2020.e00755
• Languages: English
• ISSNs: 2214-2509

Abstract

Abstract: 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.