Disseminated Nocardia brasiliensis causing septic arthritis in a patient with non-small cell lung adenocarcinoma: a case report.
5 affiliations
- 1Memorial Healthcare System, Hollywood, FL, USA. [email protected].
- 2Department of Internal Medicine, Memorial Healthcare System, Hollywood, FL, USA. [email protected].
- 3Nova Southeastern University, Fort Lauderdale, FL, USA.
- 4Memorial Healthcare System, Hollywood, FL, USA.
- 5Department of Internal Medicine, Memorial Healthcare System, Hollywood, FL, USA.
Abstract
Background
Nocardia brasiliensis is classically associated with localized cutaneous infection and is a rare cause of disseminated disease. Septic arthritis due to Nocardia species is atypical and has rarely been reported without antecedent trauma. We present a case of N. brasiliensis septic arthritis in a patient with active solid organ malignancy.Case presentation
An 80-year-old male with non-small cell lung adenocarcinoma, chronic obstructive pulmonary disease, and chronic kidney disease stage 3b presented with refractory soft tissue infections of the left upper and right lower extremities despite prior incision and drainage and oral antibiotics. Hospital course was complicated by progressive right knee effusion. Synovial fluid analysis demonstrated 87,000 white blood cells per microliter, 95% neutrophils, glucose less than 20 mg/dL, and no crystals. Nocardia brasiliensis was cultured from multiple noncontiguous sites, including the left upper extremity abscess, right knee synovial fluid, and right lower extremity lesions. Susceptibility testing demonstrated a broad antimicrobial profile but resistance to imipenem and ciprofloxacin. Trimethoprim-sulfamethoxazole and aminoglycosides were relatively contraindicated due to renal function. The patient required right knee arthroscopy with irrigation, debridement, and complete synovectomy, multiple interventional radiology-guided drainages, and prolonged combination antimicrobial therapy with ceftriaxone, linezolid, and minocycline. His course was further complicated by persistent encephalopathy and severe malnutrition requiring enteral nutrition. At the time of reporting, the patient demonstrated clinical improvement of cutaneous and musculoskeletal lesions but remained hospitalized for non-infectious complications.Conclusions
This case highlights that Nocardia brasiliensis can cause disseminated musculoskeletal infection including septic arthritis in immunocompromised patients without clear environmental exposure. In patients with chronic kidney disease, standard first-line therapies may be contraindicated, making early species identification and susceptibility-guided therapy essential, particularly given the potential for carbapenem resistance. The central lesson is that empiric carbapenem therapy may fail in N. brasiliensis and that renal impairment narrows treatment options, so timely identification and susceptibility-directed therapy directly determine management, particularly when advanced malignancy further constrains care.
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BibTeX
@article{jundi2026disseminated,
title = {{Disseminated Nocardia brasiliensis causing septic arthritis in a patient with non-small cell lung adenocarcinoma: a case report.}},
author = {Issa Jundi and Wafa Asad and Priyanka Mehotra and Andres Reyes-Corcho},
journal = {BMC infectious diseases},
year = {2026},
month = jul,
doi = {10.1186/s12879-026-14064-1},
url = {https://europepmc.org/article/MED/42902226},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Disseminated Nocardia brasiliensis causing septic arthritis in a patient with non-small cell lung adenocarcinoma: a case report.
AU - Issa Jundi
AU - Wafa Asad
AU - Priyanka Mehotra
AU - Andres Reyes-Corcho
PY - 2026
DA - 2026/07/01
JO - BMC infectious diseases
DO - 10.1186/s12879-026-14064-1
UR - https://europepmc.org/article/MED/42902226
AB - Background Nocardia brasiliensis is classically associated with localized cutaneous infection and is a rare cause of disseminated disease. Septic arthritis due to Nocardia species is atypical and has rarely been reported without antecedent trauma. We present a case of N. brasiliensis septic arthritis in a patient with active solid organ malignancy.Case presentation An 80-year-old male with non-small cell lung adenocarcinoma, chronic obstructive pulmonary disease, and chronic kidney disease stage 3b presented with refractory soft tissue infections of the left upper and right lower extremities despite prior incision and drainage and oral antibiotics. Hospital course was complicated by progressive right knee effusion. Synovial fluid analysis demonstrated 87,000 white blood cells per microliter, 95% neutrophils, glucose less than 20 mg/dL, and no crystals. Nocardia brasiliensis was cultured from multiple noncontiguous sites, including the left upper extremity abscess, right knee synovial fluid, and right lower extremity lesions. Susceptibility testing demonstrated a broad antimicrobial profile but resistance to imipenem and ciprofloxacin. Trimethoprim-sulfamethoxazole and aminoglycosides were relatively contraindicated due to renal function. The patient required right knee arthroscopy with irrigation, debridement, and complete synovectomy, multiple interventional radiology-guided drainages, and prolonged combination antimicrobial therapy with ceftriaxone, linezolid, and minocycline. His course was further complicated by persistent encephalopathy and severe malnutrition requiring enteral nutrition. At the time of reporting, the patient demonstrated clinical improvement of cutaneous and musculoskeletal lesions but remained hospitalized for non-infectious complications.Conclusions This case highlights that Nocardia brasiliensis can cause disseminated musculoskeletal infection including septic arthritis in immunocompromised patients without clear environmental exposure. In patients with chronic kidney disease, standard first-line therapies may be contraindicated, making early species identification and susceptibility-guided therapy essential, particularly given the potential for carbapenem resistance. The central lesson is that empiric carbapenem therapy may fail in N. brasiliensis and that renal impairment narrows treatment options, so timely identification and susceptibility-directed therapy directly determine management, particularly when advanced malignancy further constrains care.
SN - 1471-2334
ER -