Nocardia arthritidis Infection in an Immunocompetent Human in the United States

Osamuyimen Igbinosa^1, , Owen Igbinosa², Krishna Dass¹ and Glenn Wortmann¹

¹Section of Infectious Diseases, MedStar Washington Hospital Center, Washington DC USA

²Department of medicine, Obafemi Awolowo University Teachings Hospitals Complex, Ile-Ife, Nigeria

Cite this paper:
Osamuyimen Igbinosa, Owen Igbinosa, Krishna Dass and Glenn Wortmann. Nocardia arthritidis Infection in an Immunocompetent Human in the United States. American Journal of Medical Case Reports. 2016; 4(7):251-254. doi: 10.12691/ajmcr-4-7-10

Abstract

Patients with T-cell defects are at the highest risk for nocardiosis, a potentially life-threatening infection caused by several species of the genus, Nocardia. We report a case of disseminated Nocardia arthritidis in a patient who had no recognizable risk factors for immunodeficiency. A 43-year-old woman was noted to have a left upper lobe cavitary lesion on an outpatient computerized tomography (CT) scan that was performed for evaluation of pelvic congestion syndrome. She subsequently had an image-guided biopsy of the lesion, but the results were still pending when she presented at the emergency department with a transient episode of aphasia. A CT scan of the patient’s head revealed hypodensities in the right frontoparietal and left frontal lobes. A modified acid-fast stain on the lung biopsy specimen demonstrated variable, branching, filamentous bacteria with morphology consistent with Nocardia species. Matrix-Assisted Laser Desorption / Ionization – Time-of-Flight (MALDI-TOF) Mass Spectrometry at a reference laboratory later identified the bacteria as Nocardia arthritidis. This case highlights that disseminated nocardiosis can occur in an apparently healthy population. A more detailed immunologic evaluation that include screening for chronic granulomatous disease, anticytokine autoantibody deficiency and interleukin-12-gamma interferon pathway deficiency may further assist in the diagnosis of patients’ underlying diseases.

Keywords:
Norcadiosis Norcadia arthritidis Immunocompromised

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