Disseminated Nocardiosis – A rare case of Nocardia kroppenstedtii in a Ghanaian adult – A case report
Keywords:
Nocardiosis, SLE, ImmunocompromisedAbstract
Aims: The aim of this report is to present a rare case of disseminated Nocardia kroppenstedtii infection in an immunocompromised patient with Systemic Lupus Erythematosus (SLE), highlighting the diagnostic challenges and management complexities with a resource-limited setting.
Case presentation: A 43-year-old Ghanaian woman with a history of SLE and Lupus nephritis on long-term corticosteroids presented with respiratory distress, fever, and cutaneous ulcers. Clinical evaluation revealed sepsis from infected cutaneous ulcers and bilateral pneumonia, acute kidney injury, and features of lupus myocarditis. Cultures from her leg ulcers and blood cultures isolated Nocardia kroppenstedtii. Imaging later confirmed a perinephric abscess, and bilateral pneumonia after which disseminated nocardiosis was suspected. She was treated with a prolonged course of trimethoprim-sulphamethoxazole, amikacin and meropenem, alongside management of lupus myocarditis and AKI. Despite limited diagnostic tools, a multidisciplinary approach facilitated recovery back to her baseline.
Conclusion: This case underscores the importance of maintaining high clinical suspicion for nocardiosis in immunocompromised patients, especially where laboratory capabilities are limited. Early culture sampling and tailored antimicrobial therapy are key to survival in disseminated disease.
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