背景:诺卡氏菌是一种普遍存在的土壤生物。作为一种机会性病原体,吸入和皮肤接种是最常见的感染途径。肺和皮肤是诺卡心病最常见的部位。睾丸是一个非常不寻常的位置,用于诺卡孔病。
方法:我们报告一例因不明原因发热而入院的免疫功能低下的75岁男子。他在园艺后出现皮肤损伤,并首次被怀疑患有地中海斑点热,但他对强力霉素没有反应.然后,体格检查显示新的左阴囊肿胀,与附睾-睾丸炎的诊断相符.尽管经验性抗生素治疗,但患者的病情并未改善,坏死性阴囊脓肿需要手术治疗。从去除的睾丸培养物中产生了巴西诺卡氏菌。开始使用大剂量甲氧苄啶-磺胺甲恶唑和头孢曲松。在影像学研究中,在大脑和脊髓中发现了多个微脓肿。经过6周的双重抗生素治疗播散性诺卡尼病,观察到脑脓肿的轻微消退。患者经过6个月的抗生素疗程后出院,在撰写这些行时仍无复发。甲氧苄啶-磺胺甲恶唑单独使用后6个月。我们对以前报道的泌尿生殖系统和泌尿系统的诺卡尼病病例进行了文献综述;迄今为止,只有36例主要累及肾脏,前列腺和睾丸.
结论:据我们所知,这是首例同时感染皮肤的巴西诺卡氏菌,睾丸,免疫功能低下患者的大脑和脊髓。关于罕见形式的诺卡尼病的知识仍然很少。此病例报告强调了诊断非典型诺卡尼病的困难以及在经验性抗生素失败的情况下及时进行细菌学采样的重要性。
BACKGROUND: Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis.
METHODS: We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient\'s condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature
review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis.
CONCLUSIONS: To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.