engleski

Disseminated nocardiosis in a patient with newly diagnosed HIV infection

Background: Nocardia spp. are opportunistic pathogens most commonly affecting immunocompromised patients. We describe a case of disseminated nocardiosis in a patient newly diagnosed with HIV. Case report: A 45-year-old male presented with a three-week history of swelling and pain in the right knee. Purulent arthritis was diagnosed and treatment with intravenous antibiotics, arthroscopy, joint lavage and arthrotomy was undertaken. Nocardia sp. was isolated from intraoperative samples. The patient also had a history of frequent Candida balanitis and recent weight loss, so he was tested for HIV and the test came back positive. His CD4+ count at the time of HIV-diagnosis was 24 cells/uL, with a viral load of 148 353 HIV-1 RNA copies/mL of plasma. Pulmonary involvement was confirmed by a chest CT scan, multiple abscesses in lower extremities were diagnosed by ultrasonography, lower extremities CT scan, and whole-body PET-CT scan. Signs of femorotibial osteomyelitis of the right leg were also found. His brain CT scan was normal, and he didn't develop any neurologic symptoms during follow-up. He was treated with a combination of imipenem and co-trimoxazole intravenously (for a total of 73 days), which was continued with an oral regimen of co-trimoxazole and ciprofloxacin. Antiretroviral therapy (ART) with bictegravir/emtricitabine/tenofovir alafenamide was initiated, and on the 70th day of therapy his viral load became undetectable, the CD4+ count remained low (30 cells/uL). Multiple leg abscesses showed almost complete resolution, a follow-up chest CT scan showed residual small bilateral nodular infiltrates, and his general condition improved markedly. Conclusions: In patients with severely impaired cellular immunity, we can expect rare pathogens presenting with unusual clinical syndromes. Prompt diagnosis and adequate treatment of both the opportunistic disease and HIV infection is important to achieve a favorable outcome

disseminated nocardiosis ; HIV-infection

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