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Kidney Week

Abstract: TH-PO707

Disseminated Nocardiosis in an Immunosuppressed Patient with Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ait Faqih, Samia, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Sundara Raman, Krishnamoorthy, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
  • Shurrab, Alaedin, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
Introduction

Nocardiosis is a rare life-threatening opportunistic infection which has been reported in association with immunosuppressed patients. The diagnosis is challenging because of the insidious onset of symptoms with a subacute course that progresses over several weeks. Misdiagnosis and late treatment can lead to fatal consequences. We report a new case of disseminated nocardiosis (lungs, brain, eyes and joints) in a patient diagnosed with membranous nephropathy. We also review the literature and analyze the clinical characteristics and modalities of treatment of nocardiosis.

Case Description

A 49-year-old Eritrean man diagnosed with nephrotic syndrome secondary to primary membranous nephropathy with high risk progression factors. He was started on immunosuppression along with general supportive measures. He presented to the Accidents & Emergency department with fever, fatigue, productive cough, red eyes and right knee swelling since the preceding week. He was found to have pneumonia, bilateral uveitis and right septic arthritis. He had arthroscopic drainage and washout of the knee. Cultures of sputum, blood and joint came back positive growing Nocardia otitidiscaviarum. CT brain imaging revealed left occipital ring enhancing lesions with surrounding edema without mass effect suggesting brain abscess. Patient was started on Trimethoprim/Sulfamehtoxazole based on sensitivity testing and this was continued for 12 months. Immunosuppression was also stopped once the diagnosis was made and he had shown signs of remission around the same time. Patient responded very well to antibiotics and fully recovered.

Discussion

Immunosuppression is the most important predisposing factor for systemic nocardiosis. Poor outcome is mostly found in immunocompromised patients which can be improved by early detection and administration of the correct antibiotic regimen. More studies on nocardiosis are required to better identify risk factors associated with morbidity /mortality and to develop effective methods of prevention of the disease.