B73-48 Mission Possible: The Case of Elusive Pneumonia With an Omental Twist
Abstract
Abstract Nocardia is an aerobic, gram-positive, partially acid-fast bacillus widely distributed in soil and water. It primarily causes opportunistic infections but can also affect immunocompetent individuals, particularly those with structural lung diseases. Disseminated nocardiosis can involve various organs, with the central nervous system and skin being the most frequently affected sites. Nocardia Mexicana, a strain identified in 2014, has limited documentation in the literature. There has been no known report of intraabdominal nocardiosis associated with Nocardia Mexicana pneumonia. We are presenting the first known case of Nocardia Mexicana pneumonia complicated by omental dissemination that was successfully treated with intrapleural fibrinolysis therapy and antibiotics therapy with Trimethoprim/Sulfamethoxazole and Moxifloxacin. 33-year-old male construction worker with a history of 7 pack-years of smoking and multifocal pneumonia three years prior presented with a three-week history of worsening productive cough and intermittent fever, along with a one-week history of abdominal pain. Chest computed tomography (CT) revealed a left upper lobe opacity with possible cavitation and a 3 cm x 2 cm abdominal mass. An omental biopsy demonstrated necrotizing and non-necrotizing granulomatous inflammation, which tested positive for Nocardia Mexicana. The patient was initially started on antibiotics but showed resistance to therapy, necessitating intrapleural fibrinolysis for…
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