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Nocardia prostatitis in a small intestine transplant recipient
1Department of Pathology, University of Pittsburgh Medical Center and the Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA.
Summary
This case report highlights an uncommon Nocardia prostatitis infection in a small bowel transplant patient. Prompt diagnosis and a 6-month antibiotic course guided by susceptibility testing led to successful treatment and recovery.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Urology
Background:
- Small bowel transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
- Urinary tract infections (UTIs) and urolithiasis are known complications in transplant patients.
- Nocardia asteroides complex is an opportunistic pathogen that can cause severe infections in immunocompromised individuals.
Observation:
- A 37-year-old patient presented with dysuria and signs of urinary tract obstruction post-transplant.
- Initial empiric antibiotics were ineffective; cultures revealed Nocardia asteroides complex in urine and blood.
- The Nocardia isolate showed resistance to ciprofloxacin but sensitivity to ceftriaxone and sulfa drugs.
Findings:
- Nocardia prostatitis is a rare but serious complication in immunocompromised hosts.
- Treatment with ceftriaxone and trimethoprim-sulfamethoxazole resulted in clinical improvement.
- A prolonged 6-month antibiotic course was crucial for preventing relapse.
Implications:
- Nocardia prostatitis requires a high index of suspicion in transplant recipients with persistent UTIs.
- Antibiotic selection must be guided by in vitro susceptibility testing for optimal outcomes.
- Long-duration therapy is essential for eradicating Nocardia infections and preventing recurrence in this vulnerable population.