Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Nocardiosis is a rare cause of infection that usually affects immunocompromised adult patients and might not be recognized by pediatricians. We report a fatal case of disseminated nocardiosis in a previously healthy child initially admitted for an abdominal mass with suspicion of a renal malignant t...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2018-02, Vol.141 (2), p.1
Main Authors: Senard, Olivia, Blanot, Stéphane, Jouvion, Gregory, Rodriguez-Nava, Véronica, Lortholary, Olivier, Join-Lambert, Olivier, Toubiana, Julie
Format: Article
Language:English
Subjects:
Abscesses
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacteriology
Biopsy
Cerebellum
Cerebrospinal fluid
Child
Children
Children & youth
Diagnosis, Differential
Drug resistance
Drug Resistance, Multiple, Bacterial
Drug Therapy, Combination
Fatal Outcome
Fatalities
Fungicides
Humans
Immunocompetence
Immunotherapy
Infections
Kidney cancer
Lesions
Life Sciences
Male
Meningitis
Microbiology and Parasitology
Multidrug resistance
Multidrug resistant organisms
Neuroimaging
Nocardia
Nocardia - isolation & purification
Nocardia Infections - diagnosis
Nocardia Infections - drug therapy
Nocardia Infections - microbiology
Nocardiosis
Pain
Pediatrics
Risk factors
Ventricle
Virology
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Summary:Nocardiosis is a rare cause of infection that usually affects immunocompromised adult patients and might not be recognized by pediatricians. We report a fatal case of disseminated nocardiosis in a previously healthy child initially admitted for an abdominal mass with suspicion of a renal malignant tumor. The patient, originating from Mali without any medical history, displayed abdominal pain with progressive altered general status. Laboratory and imaging findings revealed lymphocytic meningitis and disseminated abscesses in the brain and the cerebellum and a large number of cystic lesions of the kidney. Despite being administered wide-spectrum antibiotics and antituberculous and antifungal therapies with an external ventricular drainage for intracranial hypertension, the patient died 6 days after his admission. spp was cultured from a renal biopsy and the cerebrospinal fluid. Species identification and antibiotic susceptibility were obtained later, revealing a multidrug-resistant isolate of the complex. This case reveals the difficulties of diagnosing nocardiosis, in particular in children not known to be immunocompromised, because we face multiple differential diagnoses and the importance of treating nocardiosis appropriately because of intrinsic resistance issues.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2016-3131