Zhang SS, Lu Y, Fu WN. Chronic renal insufficiency complicated by skin infection with Nocardia brasiliensis: A case report. World J Clin Cases 2025; 13(20): 104953 [DOI: 10.12998/wjcc.v13.i20.104953]
Corresponding Author of This Article
Ying Lu, MS, Chief Physician, Department of Nephrology, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Hangzhou 310012, Zhejiang Province, China. hz_luying@126.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2025; 13(20): 104953 Published online Jul 16, 2025. doi: 10.12998/wjcc.v13.i20.104953
Chronic renal insufficiency complicated by skin infection with Nocardia brasiliensis: A case report
Shan-Shan Zhang, Ying Lu, Wen-Ning Fu
Shan-Shan Zhang, College of Integrated Traditional Chinese and Western Medicine Clinical Medicine, Tongde Hospital of Zhejiang Province Affiliated to Zhejiang Chinese Medical University, Hangzhou 310012, Zhejiang Province, China
Ying Lu, Department of Nephrology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Wen-Ning Fu, Department of Nephrology and Rheumatology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Author contributions: Zhang SS contributed to conceptualization, methodology, data curation and analysis, writing the original draft, and visualization; Fu WN contributed to data acquisition and supervision; Lu Y contributed to writing the review and editing; and all authors have read and approved the final manuscript.
Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program, No. 2023ZF075.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The 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 Lu, MS, Chief Physician, Department of Nephrology, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Hangzhou 310012, Zhejiang Province, China. hz_luying@126.com
Received: January 7, 2025 Revised: February 25, 2025 Accepted: March 17, 2025 Published online: July 16, 2025 Processing time: 92 Days and 16.2 Hours
Abstract
BACKGROUND
Nocardiosis is a rare bacterial infection with unclear epidemiology, pathogenesis, and characteristics. Its clinical manifestations are diverse and nonspecific, making diagnosis prone to errors, including misdiagnosis and missed diagnosis. Additionally, this disease is difficult to treat, often requiring months or even years of antibacterial therapy, and can be fatal in patients with underlying conditions.
CASE SUMMARY
A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb. As a result of an initial misdiagnosis and inadequate treatment, the infection progressed, resulting in multiple rashes on his right upper limb. Local incision and drainage of pus, combined with oral antibiotics administered at a different hospital, yielded no significant improvement. Upon hospitalization, the patient’s immune function was assessed, and further local incision and drainage were performed. Cultures of the pus identified Nocardia brasiliensis. Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim, leading to the patient’s recovery. After discharge, the patient continued to take sulfamethoxazole tablets for 6 months, with complete healing of the skin lesions and no recurrence.
CONCLUSION
Nocardiosis should be considered in patients with underlying conditions and compromised immunity. Prompt and accurate diagnosis is crucial.
Core Tip: This report presents a case of primary cutaneous nocardiosis in a 93-year-old man with chronic renal insufficiency. The patient was hospitalized for immunodeficiency evaluation. After confirming infection with Nocardia brasiliensis, we initiated a low-dose treatment strategy to mitigate potential liver and kidney damage. The dosage was adjusted over time based on blood drug concentration monitoring. The patient experienced no recurrence of the rash.
