Successful Treatment of Serial Opportunistic Infections Including Disseminated Nocardiosis and Cryptococcal Meningitis in a Patient with ANCA-associated Vasculitis

Kana Iwazu; Yoshitaka Iwazu; Shin-ichi Takeda; Tetsu Akimoto; Wako Yumura; Hideaki Takahashi; Chiharu Ito; Kuniyuki Kanai; Nobuyuki Taniguchi; Yoshikazu Hirai; Eiji Kusano

doi:10.2169/internalmedicine.51.7886

CASE REPORTS

Successful Treatment of Serial Opportunistic Infections Including Disseminated Nocardiosis and Cryptococcal Meningitis in a Patient with ANCA-associated Vasculitis

Kana Iwazu, Yoshitaka Iwazu, Shin-ichi Takeda, Tetsu Akimoto, Wako Yumura, Hideaki Takahashi, Chiharu Ito, Kuniyuki Kanai, Nobuyuki Taniguchi, Yoshikazu Hirai, Eiji Kusano

Author information

Kana Iwazu
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Yoshitaka Iwazu
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Shin-ichi Takeda
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Tetsu Akimoto
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Wako Yumura
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Hideaki Takahashi
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Chiharu Ito
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
Kuniyuki Kanai
Division of Bacteriological Examination, Department of Clinical Laboratory, Jichi Medical University, Japan
Nobuyuki Taniguchi
Division of Bacteriological Examination, Department of Clinical Laboratory, Jichi Medical University, Japan
Yoshikazu Hirai
Division of Bacteriology, Department of Infection and Immunity, Jichi Medical University, Japan
Eiji Kusano
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan

Keywords: MPO-ANCA, ANCA associated vasculitis, disseminated nocardiosis, cryptococcal meningitis, immunosuppression, renal failure

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 21 Pages 3051-3056

DOI https://doi.org/10.2169/internalmedicine.51.7886

Details

Abstract

We herein present a case of serial opportunistic infections that included disseminated nocardiosis and cryptococcal meningitis in a 67-year-old man who was diagnosed with ANCA-associated vasculitis and treated with corticosteroids. Upon admission, the initial manifestations of the disease included subcutaneous tumors and multiple lesions in the brain and lungs. Nocardia farcinica was identified in a culture of the aspirated pus. The patient was successfully treated for disseminated nocardiosis with antibiotics. However, three months after discharge, he was hospitalized with complaints of nuchal pain. Cryptococcus neoformans was identified on a culture of the cerebrospinal fluid. Anti-fungal treatment resulted in the remission of cryptococcal meningitis.

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