Abstract: PO2217
Rare Presentation of Disseminated Nocardia as Syndrome of Inappropriate Antidiuretic Hormone (SIADH) in Renal Transplant
Session Information
- Transplantation: Clinical - Noninvasive Biomarkers, Immune Regulation, and Fascinomas
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Myers, Iskra, East Carolina University, Greenville, North Carolina, United States
- Parker, Joseph C., East Carolina University, Greenville, North Carolina, United States
- Richardson, Scott, East Carolina University, Greenville, North Carolina, United States
Introduction
Nocardia is a rare opportunistic pathogen that typically affects the immunocompromised host. Recently, Williams et. al. reported a third of patients have disseminated cerebral nocardiosis at presentation with most common isolate Farcinica species. SIADH has been reported in association with disease progression.
Case Description
A 31-year-old renal transplant recipient presented 4 years post-transplant with dyspnea and left upper extremity jerking. Immunosuppressives (IS) included Mycophenolate, Tacrolimus and Prednisone. He had non focal exam. Blood work showed Na 129, Uosm 500 mosm/kg, UNa 92. MRI brain showed multiple lesions, largest in left frontal area. CT chest revealed right pleural effusion. Biopsy of resected brain abscess and pleural fluid analysis both confirmed Nocardia Araoensis and Bejingensis. Imipenem and Bactrim were started, IS regimen was tapered down. Repeat scans month later showed resolution of vasogenic edema, pleural effusion and SIADH.
Discussion
Cerebral nocardiosis is life-threatening opportunistic infection that often presents with no specific clinical signs to guide diagnosis. High index of clinical suspicion is the key to early diagnosis. Presence of SIADH should prompt search for Nocardia which needs to be identified down to its species for targeted antibiotic treatment.
Branching g+ rod on gram stain, Nocardia.
Left frontal ring-enhancing lesion.