Indian Journal of Medical Research

CLINICAL IMAGES
Year
: 2016  |  Volume : 143  |  Issue : 1  |  Page : 118--119

Disseminated nocardiosis in a patient with sarcoidosis


Srinivas Rajagopala, Gurukiran Dangeti 
 Department of Medicine, Jawaharlal Nehru Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Gorimedu, Puducherry 605 006, India

Correspondence Address:
Srinivas Rajagopala
Department of Medicine, Jawaharlal Nehru Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Gorimedu, Puducherry 605 006
India




How to cite this article:
Rajagopala S, Dangeti G. Disseminated nocardiosis in a patient with sarcoidosis .Indian J Med Res 2016;143:118-119


How to cite this URL:
Rajagopala S, Dangeti G. Disseminated nocardiosis in a patient with sarcoidosis . Indian J Med Res [serial online] 2016 [cited 2020 Oct 30 ];143:118-119
Available from: https://www.ijmr.org.in/text.asp?2016/143/1/118/178625


Full Text

A 64 year old male with well-controlled diabetes mellitus and fibrocystic sarcoidosis on steroids presented to the department of Pulmonology, Manipal Hospitals, Bengaluru, India, in October 2013 with a one week history of discharging ulcer and skin rash, and one day history of seizures with altered sensorium. His medications included oxygen at 1l/min, insulin, aspirin, 15 mg prednisolone, pantoprazole and calcium. Clinical examination showed a 2x2.5 cm ulcer with clean base and serous discharge over the left thigh. Multiple 2 x 3 cm reddish non-pruritic papules were present over both lower limbs and abdomen [Figure 1]. Repeat computed tomography of the chest did not show any new consolidation or cavitation [Figure 2], but confirmed stage IV sarcoidosis. CT-head showed multiple space occupying lesions [Figure 3]A; magnetic resonance imaging of the head revealed multiple enhancing intracranial ring lesions [Figure 3]B. Cerebrospinal fluid examination showed 400 polymorphs/µl, elevated protein (105 mg/dl) and depressed sugar values (45 mg/dl, corresponding blood glucose 145 mg/dl) with normal adenosine deaminase levels (3 U/l, normal <8 U/l). Biopsy from nodules showed necrosis with lympho-mononuclear dermal infiltration and Grocott's stain revealed filamentous branching structures. Discharge from the ulcer showed long thin filamentous forms suggesting Nocardia that was confirmed on modified acid-fast staining [Figure 4]A; cultures were confirmed to be Nocardia asteroides [Figure 4]B. t0 he patient was treated with phenytoin, ceftriaxone, amikacin and oral trimethoprim-sulphamethaxazole. Insulin and oxygen were continued and prednisolone tapered. Neurological abnormalities normalized by one week. At 12 months follow up, the patient was well.{Figure 1}{Figure 2}{Figure 3}{Figure 4}

 Acknowledgment



The authors thank Dr Vikas, department of Radiology, Manipal Hospitals, Benguluru for help in reporting the neuroradiology of this index patient and Dr Srivatsav Lokeswaran, department of Pulmonary Medicine, for help in patient management.

Conflicts of Interest: None.