Nocardial abscesses have been reported in a 69-year old man from China with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The case, reported in Experimental Therapeutic Medicine, also described complete resolution of the abscesses and the ANCA-associated vasculitis after surgery and intensive antibiotic treatment.
“It has been reported that patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis become infected with Nocardia after immunosuppressive therapy, with high mortality rates due to ineffective treatment,” the authors wrote.
“In the present study, the case of an elderly patient presenting with typical multiple large nocardial abscesses with ANCA-associated vasculitis and renal insufficiency, who was treated with glucocorticoid and cyclophosphamide, is reported.”
The patient was diagnosed with ANCA-associated vasculitis (AAV), pneumonia, and renal insufficiency in September 2020. He was treated with corticosteroids, but in April 2021, he developed impaired renal function and nocardial abscesses in the hip and lung.
Conservative treatment with metronidazole sodium chloride and human albumin did not improve the lesions, so surgery was performed, followed by intensive antibiotic treatment with linezolid glucose and metronidazole sodium chloride injections.
The patient requested to be discharged and was provided with linezolid and compound trimethoprrim-sulfamethoxazole tablets along with prednisone. The lung abscess disappeared 11 days after discharge and the antibiotics were discontinued.
After 6 months, the prednisone was also discontinued, and for 1 year of follow-up, the patient was stable and had normal renal function (serum creatinine 87 µmol/l) and negative myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA).
The authors note that high mortality-associated Nocardia infection is not entirely uncommon in patients with autoimmune diseases such as AAV, and it should be suspected in patients with systemic symptoms or locally encapsulated effusion. They recommend early diagnosis and the precise use of appropriate antibiotics to improve the prognosis of these cases.
Chen X, Fan Y, Zhang Y. Multiple nocardial abscesses secondary to anti‑neutrophil cytoplasmic antibody‑associated vasculitis in an elderly patient: a case report and literature review. Exp Ther Med. Published online January 30, 2023. doi:10.3892/etm.2023.11814