Disseminated Nocardiosis: A Rare Infectious Complication Following Non–Heart-Beating Donor Liver Transplantation

• Published in: Transplantation proceedings Vol. 41; no. 6; pp. 2495 - 2497
• Main Authors: Jimenez-Galanes Marchan, S, Meneu Díaz, J.C, Caso Maestro, O, Perez Saborido, B, Moreno Elola-Olaso, A, Abradelo Usera, M, Fundora Suarez, Y, Gimeno Calvo, A, Moreno Molinero, V, Garcia Reyne, A, Barra Valencia, V, San Juan Garrido, R, Moreno Gonzalez, E
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-07-2009; Elsevier
• Subjects: Abscess - microbiology; Aged; Anastomosis, Surgical - methods; Bacterial diseases; Biological and medical sciences; Brain Death; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - drug therapy; Human bacterial diseases; Humans; Infectious diseases; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Lung Diseases - diagnostic imaging; Lung Diseases - microbiology; Male; Medical sciences; Methylprednisolone - therapeutic use; Miscellaneous; Nocardia - drug effects; Nocardia - isolation & purification; Nocardia Infections - diagnostic imaging; Radiography, Thoracic; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Ultrasonography; Digestive system; Actinomycosis; Liver; Homotransplantation; Infection; Medicine; Nocardiosis; Treatment; Surgery; Bacteriosis; Non heart-beating donor; Complication; Graft; Disseminated; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.05.011

Abstract Nocardiosis is an infrequent disease that affects patients who display a cellular immunodeficiency, such as transplant recipients on immunosuppressive treatment, but uncommonly associated with high morbidity and mortality rates. Disseminated Nocardiosis affecting the central nervous system (CNS), abdomen, skin, and lungs has been described in bone marrow, lung, and kidney transplant recipients. However, to our knowledge, no cases involving all of these structures have been reported in liver transplant recipients. Herein, we have reported a case of CNS, pulmonary, and cutaneous nocardiosis in a liver transplant recipient who experienced hepatitis C virus–related cirrhosis and hepatocellular carcinoma and received the organ from a non–heart-beating donor. At posttransplantation month 7 the patient was admitted to the emergency department with poor general health status, fever, edema, and subcutaneous nodules in the legs. A computed tomography scan revealed multiple nodules disseminated through both lungs, abdomen, brain, and subcutaneous tissue. A needle biopsy was performed into one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazole-trimethoprim (SMZ-TMP), shifting after 1 month to oral therapy. Radiological examination performed after 2 weeks of treatment showed a 70% reduction in subcutaneous, pulmonary, and cerebral lesions. After 6 months of SMZ-TMP treatment, the patient remained free of the symptoms with involution of the subcutaneous nodules and significant radiological improvement. Among opportunistic infections appearing in liver transplant recipients, Nocardia species should have special consideration according to the success of early treatment and the bad prognosis in cases of delayed diagnosis.