Disseminated nocardiosis masking an atypical zygomycosis presentation in a kidney transplant recipient

• Published in: Transplant infectious disease 2011-08, Vol.13 (4), p.380-384
• Main Authors: Colón‐Santos, E., González‐Ramos, M., Bertrán‐Pasarell, J., Rodríguez‐Vega, G., Almira‐Suarez, M., Vélez‐Rosario, R.
• Format: Article
• Language: English
• Subjects: Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Brain Abscess - complications; Brain Abscess - diagnosis; Brain Abscess - drug therapy; Brain Abscess - microbiology; Coinfection - diagnosis; Coinfection - microbiology; Female; Humans; kidney transplant; Kidney Transplantation - adverse effects; Middle Aged; mucormycosis; Nocardia; Nocardia - isolation & purification; Nocardia Infections - complications; Nocardia Infections - diagnosis; Nocardia Infections - diagnostic imaging; Nocardia Infections - drug therapy; nocardiosis; Opportunistic Infections - diagnosis; Opportunistic Infections - drug therapy; Opportunistic Infections - microbiology; Pneumonia, Bacterial - complications; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - diagnostic imaging; Pneumonia, Bacterial - drug therapy; posaconazole; Radiography; Triazoles - therapeutic use; zygomycosis; Zygomycosis - complications; Zygomycosis - diagnosis; Zygomycosis - diagnostic imaging; Zygomycosis - microbiology
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/j.1399-3062.2011.00606.x

E. Colón‐Santos, M. González‐Ramos, J. Bertrán‐Pasarell, G. Rodríguez‐Vega, M. Almira‐Suarez, R. Vélez‐Rosario. Disseminated nocardiosis masking an atypical zygomycosis presentation in a kidney transplant recipient.
Transpl Infect Dis 2011: 13: 380–384. All rights reserved : Immunosuppressive agents increase the vulnerability of solid organ transplant patients to opportunistic infections. An atypical clinical presentation of a bacterial and fungal co‐infection makes diagnosis and treatment even more challenging in this population. A 54‐year‐old hypertensive woman underwent a cadaveric kidney transplant after years on hemodialysis. Her treatment included mycophenolate, tacrolimus, and prednisone. By post‐transplant week 8, she had pneumonia followed by progressive visual changes and seizures. Diagnostic work‐up, consisting of magnetic resonance imaging of the brain and chest x‐ray, showed several cerebral ring‐enhancing lesions, and a pulmonary cavitary lesion. Disseminated nocardiosis was suspected and therapy was started. Skin biopsy was taken from a nodular lesion and culture confirmed Nocardia species infection. During hospitalization, neurological deficit persisted with worsening of brain lesions. She underwent excision of a brain abscess and the final pathologic report showed mucormycosis, revealing the patient's co‐infection by 2 different pathogens. After therapy with liposomal amphotericin B and posaconazole, she has remained stable for more than 1 year. Disseminated nocardiosis masked and delayed the diagnosis and treatment of a more aggressive and worrisome organism. Mucormycosis, as a non‐fatal isolated brain abscess without rhinal involvement, is an atypical presentation, and only a few cases have been reported.