Abdominal Abscesses Caused by Nocardia farcinica in an Immunocompromised Patient: A Case Report and Literature Review

Abstract

Nocardiosis is mainly an opportunistic infection that affects immunosuppressed individuals, with the most common manifestation being the pulmonary infection and cerebral abscesses. Abdominal abscesses caused by Nocardia is rare in diabetes patients. Here, we report a rare case of abdominal abscesses caused by Nocardia farcinica (N. farcinica) in a 56-year-old man with poorly controlled type 2 diabetes and prolonged use of corticosteroids for the treatment of secondary adrenal insufficiency. Abdominal CT suggested abdominal abscesses, and the culture of the abscess puncture fluid identified it as N. farcinica by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Treatment with a combination of trimethoprim-sulfamethoxazole (TMP-SMX) and imipenem/cilastatin (IPM/CS), along with surgical drainage and reduction in corticosteroid dosage, achieved successful outcomes in treating disseminated abdominal abscesses. Immunocompromised patients with unexplained fever, abdominal pain, and abdominal abscess should be suspected of Nocardia infection.

Keywords:

• abdominal nocardiosis
• Nocardia farcinica
• abdominal abscesses
• diabetes
• corticosteroid

Abbreviations

MALDI-TOF MS, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; TMP-SMX, trimethoprim-sulfamethoxazole. IPM/CS, impenem/cilastatin; CNS, central nervous system.

Data Sharing Statement

All the data are fully available without restriction.

Ethics Approval and Patient Consent

Written informed consent was obtained from the patient for the publication of the case details. The study was approved by the medical ethics committee of The People’s Hospital of Guangxi Zhuang Autonomous Region.

Acknowledgments

We would like to acknowledge the reviewers for their helpful comments on this paper.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflict of interest in this work.

Additional information

Funding

This study was supported by the Guangxi Natural Science Foundation under Grant No. 2023GXNSFBA026068.