Disseminated Nocardia pseudobrasiliensis infection in a case of juvenile systemic lupus erythematosus on immunosuppressive therapy.
Kaustav Bhowmick, Angan Karmakar, Dipendranath Ghosh et al.
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Case in brief
A juvenile patient with systemic lupus erythematosus on immunosuppressive therapy developed disseminated Nocardia pseudobrasiliensis infection, presenting as necrotizing pneumonia, subcutaneous nodules, and a central nervous system lesion. This occurred after an inadvertent increase in steroid dosage. The patient was treated with intravenous meropenem, amikacin, and oral cotrimoxazole for 6 weeks, resulting in resolution of pneumonia and partial improvement of other lesions.
What made this case unusual
The case highlights the occurrence of disseminated nocardiosis in a juvenile lupus patient, which is uncommon and presents with severe manifestations including CNS involvement.
Diagnostic / clinical pearl
Clinicians should consider nocardiosis in immunocompromised patients presenting with pneumonia and atypical lesions, especially following changes in immunosuppressive therapy.
Why it matters
This case underscores the importance of monitoring immunosuppressed patients for opportunistic infections like nocardiosis, which can present with severe and atypical clinical features.