Isolated spinal osteomyelitis caused by Nocardia farcinica in an immunocompetent patient: A case report and literature review

Rationale: Nocardia spp. are opportunistic pathogens that invade the human body via respiratory inhalation or direct skin wounds. Spinal nocardial osteomyelitis is a rare disease with only a few cases reported to date. To the best of our knowledge, this is the second case of spinal osteomyelitis caused by Nocardia farcinica . Patient concerns and diagnoses: A 12-year-old immunocompetent girl was diagnosed with spinal osteomyelitis. The causative agent has been confirmed as N farcinica by metagenomic next-generation sequencing analysis of vertebral biopsy tissue in December 2022. It was noteworthy that the onset of the disease in this patient was insidious and the symptoms were atypical, which differed from previously reported cases. Interventions: Trimethoprim/sulfamethoxazole was given first, showing good clinical effects. To clarify the changes in the patient’s condition, we performed magnetic resonance imaging (MRI) and computed tomography examinations on the patient in August 2023. Outcomes: After 2 months of medication, the patient’s clinical symptoms completely disappeared. The results of the latest computed tomography and MRI scans showed the formation of hardened bone in the area of the L2 vertebral body bone erosion, and MRI showed a significant reduction in the abnormal signal range of the L2 vertebral body, which was considered cured. Lessons: This study suggests that N farcinica , a rare pathogen, can present with atypical symptoms and can easily be misdiagnosed in immunocompromised patients. Its diagnosis relies on advanced testing techniques, and determining the nature of the pathogen is of great significance for a clear diagnosis. Moreover, early, sufficient, and comprehensive treatment with sulfonamide antibiotics or combination therapy usually results in a good prognosis.