Loading
Diverticular Disease and Complications / Actinomycetales Infections and Treatment / Infectious Disease Case Reports and Treatments · Journal article
Cureus · August 8, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of disseminated Nocardia farcinica infection presenting as multifocal intramuscular and cerebral abscesses in a corticosteroid-treated patient with hepatocellular carcinoma, initially misdiagnosed as metastatic disease. The case illustrates the diagnostic pitfall of attributing new soft-tissue masses to cancer metastases in immunosuppressed patients and emphasizes the value of tissue sampling and integrated clinical assessment before definitive treatment.
Case report. A 67-year-old man with hepatocellular carcinoma and prior pulmonary metastasis resection, receiving prednisolone for immune-related interstitial nephritis. Intervention: Surgical drainage of purulent collection and prolonged combination antimicrobial therapy.
Nocardia farcinica identified by blood culture and direct smear examination of purulent fluid from intramuscular abscess Multifocal involvement: right forearm, left gluteus medius, left obturator internus, and multiple cerebral abscesses Patient improved after surgical drainage and prolonged combination antimicrobial therapy following discontinuation of palliative radiotherapy
Patient improved after surgical drainage and prolonged combination antimicrobial therapy following discontinuation of palliative radiotherapy
Clinicians should maintain a low threshold for tissue diagnosis of new soft-tissue masses in immunosuppressed cancer patients before attributing them to metastases, and consider infectious mimics such as nocardial abscess when imaging and clinical findings are equivocal. Integrating physical examination (edema, localized inflammation), laboratory abnormalities (leukocytosis, elevated inflammatory markers), and imaging is essential before committing to palliative therapy.
A single case report of disseminated Nocardia farcinica infection in an immunosuppressed patient; valuable for clinical recognition but lacks comparative or quantitative evidence.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should maintain a low threshold for tissue diagnosis of new soft-tissue masses in immunosuppressed cancer patients before attributing them to metastases, and consider infectious mimics such as nocardial abscess when imaging and clinical findings are equivocal. Integrating physical examination (edema, localized inflammation), laboratory abnormalities (leukocytosis, elevated inflammatory markers), and imaging is essential before committing to palliative therapy.
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.
A 67-year-old man with hepatocellular carcinoma and a previously resected pulmonary metastasis was receiving prednisolone for immune-related interstitial nephritis. Two months after pulmonary metastasectomy, multiple pulmonary nodules and painful intramuscular masses developed in the right forearm, left gluteus medius, and left obturator internus. The lesions were initially interpreted as metastases, and palliative radiotherapy was initiated. At the initial radiation oncology consultation, the patient was afebrile but had right forearm edema, neutrophilic leukocytosis, and an elevated C-reactive protein level. After 21 Gy in seven fractions to the right forearm, rapidly progressive swelling and pain led to emergency decompression for acute compartment syndrome. A purulent collection was identified; blood culture grew Nocardia farcinica, and direct smear examination of aspirated fluid showed branching filamentous Gram-positive bacteria consistent with Nocardia species. Subsequent brain magnetic resonance imaging demonstrated multiple cerebral abscesses. Radiotherapy was discontinued, and the patient improved after drainage and prolonged combination antimicrobial therapy. This case demonstrates that multifocal nocardial infection may be mistaken for metastatic disease in a corticosteroid-treated patient with cancer and emphasizes the need to integrate physical examination, laboratory abnormalities, and imaging findings before treating unbiopsied soft-tissue lesions.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.