Rationale: Nocardiosis is an uncommon but serious opportunistic infection in immunocompromised patients, particularly following haematopoietic stem cell transplantation (HSCT). Nocardia farcinica is notable for its virulence and tendency to cause disseminated disease. Patient concerns: A female HSCT recipient presented several months post-transplant with progressive left shoulder pain unresponsive to conservative management. Diagnosis: Magnetic resonance imaging revealed an abscess involving the acromioclavicular joint and surrounding musculature. Histopathology showed filamentous, branching Gram-positive bacilli, and microbiological identification confirmed Nocardia farcinica . Chest imaging demonstrated pulmonary involvement consistent with disseminated nocardiosis. Interventions: Combination antimicrobial therapy with imipenem, amikacin, and trimethoprim-sulfamethoxazole was initiated, followed by prolonged oral therapy. Outcomes: The patient achieved complete clinical and radiological resolution with no relapse. Lessons: Early recognition and timely initiation of appropriate combination antimicrobial therapy are essential for favourable outcomes in disseminated nocardiosis after HSCT.
Trivedi et al. (Sun,) studied this question.