SLE complicated with Nocardia farcinica bloodstream infection and disseminated nocardiosis: a case report

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BACKGROUND: Nocardia farcinica, a gram-positive filamentous bacterium, is predominantly found in individuals with compromised immune systems. Bacteremia caused by Nocardia farcinica is relatively rare. CASE PRESENTATION: A 58-year-old woman who was diagnosed with systemic lupus erythematosus (SLE) for more than three months presented with a fever that persisted for three days. Following comprehensive diagnostic evaluations, including antinuclear and anti-dsDNA antibody tests, electrocardiogram, lung CT, MRI, and cultures of blood and sputum, the patient was diagnosed with Nocardia farcinica bloodstream infection and disseminated Nocardia disease affecting the intracranial, endocardial, and pulmonary regions. The patient was administered a combination ofsulfamethoxazole‒trimethoprim tablets and linezolid, for anti-infective therapy. Throughout the treatment course, the patient developed symptoms, including headache, chest pain, and back pain, which escalated to sudden confusion, pupil dilation, and ultimately cardiac arrest. Despite resuscitation efforts, the patient died. CONCLUSION: The clinical manifestations and imaging findings of nocardiosis are nonspecific, and diagnosis largely depends on pathogen identification. Clinicians should maintain a high level of suspicion for nocardiosis in immunocompromised patients, particularly those with long-term use of corticosteroids or immunosuppressive agents, and closely monitor the risk of disseminated infection secondary to Nocardia bloodstream infection. Early diagnosis and appropriate use of multiple antibiotics are crucial. In cases of disseminated nocardiosis, especially when critical sites such as the central nervous system or endocardium are involved, a three-drug regimen is recommended to control the infection more effectively and improve patient survival outcomes. CLINICAL TRIAL: The manuscript is a case report; therefore, I declare that a Clinical Trial number is not applicable.

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