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CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 74-77

Disseminated nocardiosis in a young male with nephrotic syndrome


1 Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Radiadiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Hiralal
Department of Radiadiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-8775.177513

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A 20-year-old male with 10 years history of treatment for nephrotic syndrome was admitted with 1 month history of fever with chills, productive sputum, pleuritic chest pain, exertional breathlessness, anorexia and 10 days history of vomiting off/on associated with headache. Gram staining of the sputum revealed gram-positive and acid-fast Bacilli by Ziehl–Neelsen staining which had a branching and fragmented morphology suggestive of Nocardia. Computed tomography of the thorax was suggestive of bilateral multiple nodules with cavitation and breakdown and minimal pleural effusion on the right, pleural fluid was turned exudative in nature, and cultures were negative for bacterial and mycobacterial. Contrast magnetic resonance imaging brain revealed multiple nodular lesions in cerebellum and cerebalar hemisphere, the majority of the lesions are showing ring enhancement. Cerebrospinal fluid did not show any abnormality. A provisional diagnosis of disseminated nocardiosis was made. The patient has started a treatment with oral trimethoprim/sulphamethoxazole, injectable ceftriaxone and imipenem for 1 month, and on regular follow–up, he had a marked clinical and radiological improvement.


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