Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Images of the month 2: Disseminated nocardiosis in a 60-year-old woman with sarcoidosis

Ofer Perzon and Hila Elinav
Download PDF
DOI: https://doi.org/10.7861/clinmed.2021-0745
Clin Med March 2022
Ofer Perzon
AHadassah Hebrew University Medical Center, Jerusalem, Israel
Roles: resident in internal medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: ofer.perzon@gmail.com
Hila Elinav
BHadassah Hebrew University Medical Center, Jerusalem, Israel
Roles: specialist in infectious diseases
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading
KEYWORDS:
  • Nocardiosis
  • sarcoidosis

Case presentation

A 60-year-old woman presented with fever, myalgia and painful subcutaneous nodules for 2 weeks. She had a history of pulmonary sarcoidosis, treated with prednisone 20 mg daily in the previous 3 months. Physical examination was remarkable for fever (38.7°C) and multiple tender subcutaneous and muscular nodules on her limbs. Laboratory abnormalities included leukocytosis (14,000 per mm3), neutrophilia (95%) and elevated C-reactive protein (12 mg/dL). Total body computed tomography (CT) revealed disseminated abscesses (Fig 1a and 1b) and magnetic resonance imaging (MRI) of the brain indicated occipital and frontal lesions (Fig 1c). Drainage of one nodule resulted in pus that was negative on microscopy, but 5 days later colonies of filamentous Gram-positive branching rods appeared on chocolate agar identified as Nocardia brasiliensis (Fig 1d). The patient was diagnosed with disseminated nocardiosis and was treated with high-dose trimethoprim–sulfamethoxazole, and linezolid later switched to minocycline due to myelosuppression, resulting in dramatic clinical, laboratory and radiological improvement after 4 months.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

a) Coronal computed tomography section of the limbs, showing multiple subcutaneous and muscular abscess. b) Coronal computed tomography section of the lungs, showing left upper lobe cavitary lesion. c) Axial magnetic resonance imaging of the brain, showing a frontal lobe small ring enhanced lesion. d) Filamentous Gram-positive branching rods on chocolate agar.

  • © Royal College of Physicians 2022. All rights reserved.
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Images of the month 2: Disseminated nocardiosis in a 60-year-old woman with sarcoidosis
Ofer Perzon, Hila Elinav
Clinical Medicine Mar 2022, 22 (2) 165; DOI: 10.7861/clinmed.2021-0745

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Images of the month 2: Disseminated nocardiosis in a 60-year-old woman with sarcoidosis
Ofer Perzon, Hila Elinav
Clinical Medicine Mar 2022, 22 (2) 165; DOI: 10.7861/clinmed.2021-0745
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Case presentation
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Images of the month 1: Histoacryl glue embolisation to the right ventricle following treatment for gastric varices
  • Image of the month: ‘Hourglass left ventricle’ in mid-ventricular hypertrophic cardiomyopathy
Show more Image of the month

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians