Nocardiosis in glomerular disease patients with immunosuppressive therapy
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RESEARCH ARTICLE
Open Access
Nocardiosis in glomerular disease patients with immunosuppressive therapy Yuzhang Han†, Zineng Huang†, Huifang Zhang†, Liyu He, Lin Sun, Yu Liu, Fuyou Liu and Li Xiao*
Abstract Background: Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods: We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results: It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions: It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases. Keywords: Nocardiosis, Glomerular disease, Glucocorticoids, Sulfanilamide
Background Glomerular diseases are still common causes of end-stage renal disease (ESRD), a global health epidemic affecting more than 2 million people worldwide [1–4]. Many glomerular diseases are immunologically mediated disorders [1, 5–8], and immunosuppressive medications put glomerular disease patients at a high risk of various infections, such as pneumonia, Mycobacterium tuberculosis and hepatitis B * Correspondence: [email protected] † Yuzhang Han, Zineng Huang and Huifang Zhang contributed equally to this work. Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
virus reactivation, which contribute to the progression of disease per se and mortality [9–14]. In recent years, accumulating data have shown an increased rate of opportunistic infections in glomerular disease patients with longterm use of glucocorticoids an
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