Occupational hazard in an immunosuppressed patient

Area of Science:

• Infectious Diseases
• Transplant Surgery
• Neurology

Background:

• Liver transplant recipients on immunosuppression are susceptible to opportunistic infections.
• Primary sclerosing cholangitis is a common indication for liver transplantation.
• Tacrolimus monotherapy is a standard immunosuppressive regimen post-transplant.

Observation:

• A 60-year-old male liver transplant recipient presented with partial seizures and headache.
• Imaging revealed bilateral ring-enhancing cerebral lesions with restricted diffusion.
• Extensive Nocardia farcinica infection was diagnosed across multiple body sites.

Findings:

• Cerebrospinal fluid analysis was unremarkable, ruling out common CNS infections.
• Extensive Nocardia farcinica infection was confirmed through fine needle aspiration and microscopy.
• The patient's low tacrolimus levels suggested potential non-adherence or altered metabolism.

Implications:

• Nocardia farcinica should be considered in the differential diagnosis of central nervous system lesions in immunocompromised patients.
• Prompt diagnosis and targeted antimicrobial therapy are essential for favorable outcomes.
• This case highlights the importance of vigilant monitoring for opportunistic infections in liver transplant recipients.