P24 | A case of nocardiosis mimicking metastatic pulmonary neoplasm

F. Bozzao, G. Bucca, M. Bon, G. Sartori, P. Valenti | Medicina Generale, ULSS 2 “Marca Trevigiana”, Oderzo (TV), Italy

Premises: Nocardia spp can cause localized or disseminated infections to skin, lungs and central nervous system, mostly in immunocompromised individuals.
Description of the Case report: A 65-year-old male is actually recovered in our clinical unit because of seizures and a rapidly growing skin lesion at the left hemithorax. No relevant history, except for past smoking and work in a pest control company. Head CT at admission has shown multiple cerebral lesions, with a thin enhancing rim and surrounding edema at the subsequent whole body scan with contrast. The latter has also revealed: A 48x56 mm lesion in the left lung surrounded by cavitary lesions and thoracic lymphadenopathy; colliquative necrosis inside the left-hemithorax lesion, which deepens to the pectoral muscle; non-homogeneous 25 mm nodules at both the adrenal glands. Given this, we initially hypothesized metastatic pulmonary neoplasm, but microscopic examination of the necrotic tissue of the left-hemithorax lesion has revealed filamentous gram-positive branching rods, suggestive of Nocardia spp. HIV and mycobacteria tests are negative. Empiric antibiotic treatment with Imipenem, TMP-SMX and Amikacin is actually underway while awaiting the results of species identification and antibiotic susceptibility.
Conclusions: Nocardiosis can mimic metastatic pulmonary neoplasm and can also occur in apparently immunocompetent hosts.