Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2025; 13(24): 108115
Published online Aug 26, 2025. doi: 10.12998/wjcc.v13.i24.108115
Chronic renal insufficiency and Nocardia brasiliensis infection: A call for heightened vigilance and multidisciplinary management
Jing Ding, Dan-Dan Shi, Ju Tian
Jing Ding, Dan-Dan Shi, Department of Plastic Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, Guangdong Province, China
Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, Guangdong Province, China
Co-first authors: Jing Ding and Dan-Dan Shi.
Author contributions: Ding J and Shi DD contributed equally to this work as co-first authors. Ding J and Shi DD provided crucial and indispensable contributions to the completion of this project; Tian J designed the overall concept and manuscript outline.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Ju Tian, Department of Burns and Plastic Surgery, Zhongshan City People’s Hospital, Sunwen East Road, Zhongshan 528400, Guangdong Province, China. tian-ju@163.com
Received: April 7, 2025
Revised: April 23, 2025
Accepted: May 13, 2025
Published online: August 26, 2025
Processing time: 72 Days and 3.2 Hours
Abstract

This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al, emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age, comorbidities, and immunocompromised populations. The study’s strengths included its integration of immunological profiling and precision medicine, demonstrating that a tailored low-dose trimethoprim-sulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks. However, its limitations included a single-case design, reliance on phenotypic diagnostics, and the lack of information regarding comorbidity interactions. The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection. Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization, developing biomarkers for early detection, and conducting global epidemiological studies in endemic regions. This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.

Keywords: Chronic renal insufficiency; Nocardia brasiliensis; Skin infection; Immunocompromised patients; Multidisciplinary management

Core Tip: This study highlights the interplay of chronic renal insufficiency and Nocardia brasiliensis infection in immunocompromised patients. A tailored low-dose sulfamethoxazole-trimethoprim regimen with pharmacokinetic monitoring improved outcomes in a geriatric patient. Future research needs advanced diagnostics, biomarker development, and global epidemiological studies.