Abstract: SA-PO1165
Nonpulmonary Nocardiosis Presenting as Intramuscular and Cerebral Abscess in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Harish, Rachana, Medical City Fort Worth, Fort Worth, Texas, United States
- Palani, Maanasa, Medical City Fort Worth, Fort Worth, Texas, United States
- Balamuthusamy, Saravanan, Medical City Fort Worth, Fort Worth, Texas, United States
- Madhrira, Machaiah M., Medical City Fort Worth, Fort Worth, Texas, United States
Introduction
Nocardiosis affects 0.3–1.1% of kidney transplant recipients and typically manifests with pulmonary involvement. Disseminated disease without pulmonary findings is exceptionally rare. We report a unique case of intramuscular abscess with incidental cerebral involvement in a renal transplant recipient, highlighting the importance of systematic CNS surveillance in this population.
Case Description
A 48-year-old female, four years post-kidney transplantation on tacrolimus, mycophenolate mofetil, and prednisone, presented with progressive left calf pain and swelling. CT revealed biceps femoris and soleus muscle abscesses. Aspiration culture identified Nocardia cyriacigeorgica. Chest CT showed no pulmonary infiltrates. Brain MRI was performed due to elevated CNS dissemination risk despite the absence of neurological symptoms, and revealed a right posterior temporal lobe abscess. Initial combination therapy with renally-dosed TMP-SMX, imipenem, and linezolid was initiated after susceptibility testing; however, TMP-SMX was discontinued following a rise in serum creatinine and replaced with minocycline. Serial imaging demonstrated progressive resolution of both intramuscular and cerebral abscesses. The patient completed 12 months of combination antimicrobial therapy without relapse and maintained stable allograft function.
Discussion
Three critical teaching points: (1) nocardiosis can present with isolated extrapulmonary disease (2) CNS imaging is warranted in all transplant patients with nocardiosis regardless of neurological status, as up to 43% of CNS cases are asymptomatic and (3) intramuscular abscess is exceptionally rare, with fewer than 12 reported cases. Successful outcomes require early species-level identification, individualized therapy with attention to renal toxicity, and judicious immunosuppression reduction.