DisseminatedNocardia farcinicapost haematopoietic stem cell transplantation: A case report

Abstract

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.

Keywords

Haematopoietic stem cell transplantation / Disseminated nocardiosis / Musculoskeletal infection / Immunocompromised host / Case report

Conflict of interest statement

The authors declare that there are no conflicts of interest related to this manuscript. No material from external published sources has been reproduced, and no additional copyright permissions were required. We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the journal, in the event that such work is published by the journal.

Presentation at a meeting

Presented at Tata Memorial Centre, Mumbai, on 3 March 2025.

Ethical considerations and patient’s consent

All images included in this manuscript were obtained from the authors’ institution during routine clinical care. The treating physicians are among the authors. All images have been anonymised to protect patient identity. A waiver of patient consent for publication was granted by the Institutional Ethics Committee, as the report relates to retrospective clinical care and contains no identifiable patient information.

Funding

This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

AT, NS, and RJ contributed equally to the conception and design of the case report, data collection and interpretation, literature review, and drafting of the manuscript. MK, SC, GB, SS, KR, ID, and AM contributed to patient evaluation and management and provided critical revision of the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Pan Y, Lei Y, Zhang Q

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