A69-27 Disseminated Nocardiosis Secondary to Chronic Prednisone Abuse: A Case Report

Background Nocardia is a Gram-positive bacterial species that affects both humans and other animals. In humans, they typically affect immunocompromised individuals. In disseminated nocardiosis, it can infect any organ system, but especially the CNS(24-46%) and lungs, and is rare to spread to the soft tissue or abdominal organs. Case 44 year old female with previous history of hypertension, remote drug abuse, and chronic low back pain presents with dizziness and fatigue. In the ER, her imaging was significant for new brain lesions with mild mass effects, multiple pulmonary nodules, axillary and pericardial lesions, renal vein thrombus, pancreatic lesions, left kidney mass, retroperitoneal lesion, multiple subcutaneous nodules, and a new L4 compression fracture. The above findings were concerning for metastatic cancer or multifocal infection. Further history revealed that the patient had self-administered 200mg of prednisone for 4 months. MRI of the brain demonstrated multiple cystic lesions in both cerebral hemispheres, cerebellum, and vermis. Two days into the hospitalization, the blood cultures were positive for Nocardia Farcinica. She was started on IV amikacin and imipenem-cilastatin, and the Trimethoprim-sulfamethoxazole dosage was increased. The brain masses were aspirated and were found to be abscesses as well. The constellation of findings were consistent with a disseminated nocardiosis secondary to immunosuppression from prolonged high-dose corticosteroid use. Decision-Making The early involvement of multiple specialties was crucial, given this atypical presentation of prednisone abuse. She was taking an impressive amount of prednisone, predisposing her to disseminated infection involving the kidneys, pancreas, CNS, soft tissue, and lungs. However, prompt recognition and coordination of a multidisciplinary team led to the timely initiation of appropriate antibiotics, resulting in clinical improvement. Prednisone abuse is a very rare diagnosis. While this patient had a history of addiction and abuse, corticosteroid misuse/abuse is unusual. This case illustrates a unique presentation of disseminated nocardiosis involving CNS and abdominal organs secondary to prednisone abuse. It highlights the importance of maintaining a broad differential and considering infectious etiologies in patients with multiple new lesions and unexplained immunosuppression. This abstract is funded by: None