Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10120-10129
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10120
Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing: A case report and review of literature
Ting Li, Yi-Xin Chen, Jia-Jia Lin, Wei-Xian Lin, Wei-Zhen Zhang, Hang-Ming Dong, Shao-Xi Cai, Ying Meng
Ting Li, Yi-Xin Chen, Jia-Jia Lin, Wei-Xian Lin, Wei-Zhen Zhang, Hang-Ming Dong, Shao-Xi Cai, Ying Meng, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Meng Y provided this case; Li T and Chen TX wrote the manuscript; Lin JJ, Lin WX and Zhang WZ contributed significantly to manuscript preparation; Dong HM and Cai SX helped perform the analysis and contributed to constructive discussions; all authors have read and approved the final version.
Supported by the Project of Nanfang Hospital President Foundation of Southern Medical University, No. 2019C006.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that there is no conflict of interest. The patient agreed with the case report.
CARE Checklist (2016) statement: All authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Meng, Doctor, Chief Doctor, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou 510515, Guangdong Province, China. nfyymengy@163.com
Received: January 25, 2022
Peer-review started: January 25, 2022
First decision: March 23, 2022
Revised: March 25, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: October 6, 2022
Processing time: 245 Days and 0.3 Hours
Abstract
BACKGROUND

Nocardia paucivorans is an infrequently found bacterium with the potential to cause severe infection, with a predilection for the central nervous system, both in immunocompromised and immunocompetent individuals. Rapid etiological diagnosis of nocardiosis can facilitate timely and rational antimicrobial treatment. Metagenomic next-generation sequencing (mNGS) can improve the rate and reduce the turnaround time for the detection of Nocardia.

CASE SUMMARY

A 49-year-old man was admitted to hospital with cough and hemoptysis. Imaging revealed pulmonary consolidation as well as multiple brain lesions. Nocardia asiatica and Nocardia beijingensis were rapidly detected by mNGS of bronchoalveolar lavage fluid (BALF) while bacterial culture of BALF and pathological biopsy of lung tissue were negative. In early stages, he was treated with trimethoprim-sulfamethoxazole (TMP-SMZ) and linezolid by individual dose adjustment based on serum concentrations and the adverse effects of thrombocytopenia and leukopenia. The treatment was then replaced by TMP-SMZ and ceftriaxone or minocycline. He was treated with 8 mo of parenteral and/or oral antibiotics, and obvious clinical improvement was achieved with resolution of pulmonary and brain lesions on repeat imaging.

CONCLUSION

mNGS provided fast and precise pathogen detection of Nocardia. In disseminated nocardiosis, linezolid is an important alternative that can give a better outcome with the monitoring of linezolid serum concentrations and platelet count.

Keywords: Disseminated nocardiosis; Metagenomic next-generation sequencing; Linezolid; Thrombocytopenia; Case report

Core Tip: Early detection of Nocardia paucivorans can optimize antibiotic management, shorten hospital stays and improve survival rates. We report rapid detection of N. paucivorans by metagenomic next-generation sequencing (mNGS) of BALF. The patient was treated with trimethoprim-sulfamethoxazole (TMP-SMZ) and linezolid by individual dose adjustment based on serum concentration and thrombocytopenia and leukopenia, then replaced by TMP-SMZ and ceftriaxone or minocycline. This case suggests that mNGS is a convenient and efficient technique for detecting Nocardia, especially suitable for rare, novel and atypical etiologies of complicated infectious diseases. Linezolid may be an important alternative in disseminated nocardiosis.