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Diverticular Disease and Complications / Actinomycetales Infections and Treatment / Infectious Disease Case Reports and Treatments · Journal article
BMC Infectious Diseases · July 23, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of an 80-year-old man with advanced lung cancer, chronic kidney disease, and chronic obstructive pulmonary disease who developed disseminated N. brasiliensis septic arthritis with resistance to imipenem and ciprofloxacin. The patient required surgical intervention and prolonged combination therapy with ceftriaxone, linezolid, and minocycline, and showed clinical improvement of musculoskeletal lesions at the time of reporting. The case illustrates that N. brasiliensis can cause atypical disseminated infection in immunocompromised hosts and that renal impairment may preclude standard first-line treatments, requiring early microbial identification and susceptibility-directed therapy.
Case report. One 80-year-old male with non-small cell lung adenocarcinoma, chronic obstructive pulmonary disease, and chronic kidney disease stage 3b presenting with refractory soft tissue infections and progressive right knee effusion.. Intervention: Right knee arthroscopy with irrigation, debridement, and complete synovectomy; multiple interventional radiology-guided drainages; combination antimicrobial therapy with ceftriaxone, linezolid, and minocycline..
Nocardia brasiliensis cultured from multiple noncontiguous sites: left upper extremity abscess, right knee synovial fluid, and right lower extremity lesions. Synovial fluid demonstrated 87,000 white blood cells per microliter, 95% neutrophils, glucose less than 20 mg/dL, and no crystals. Organism showed resistance to imipenem and ciprofloxacin.
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should be aware that N. brasiliensis can cause disseminated musculoskeletal infection including septic arthritis in immunocompromised patients without clear environmental exposure. In patients with concurrent renal impairment, carbapenem resistance and contraindication of standard first-line agents (trimethoprim-sulfamethoxazole, aminoglycosides) emphasize the importance of rapid species identification and susceptibility-directed antimicrobial therapy combined with source control.
A single case report describing an uncommon clinical presentation; raises important clinical awareness about disseminated N. brasiliensis and antimicrobial resistance in a specific host, but cannot establish frequency, causation, or generalizable management principles.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should be aware that N. brasiliensis can cause disseminated musculoskeletal infection including septic arthritis in immunocompromised patients without clear environmental exposure. In patients with concurrent renal impairment, carbapenem resistance and contraindication of standard first-line agents (trimethoprim-sulfamethoxazole, aminoglycosides) emphasize the importance of rapid species identification and susceptibility-directed antimicrobial therapy combined with source control.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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. 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. 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.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.