Trimethoprim/sulfamethoxazole-resistant Nocardia asteroides causing multiple hepatic abscesses. Successful treatment with ampicillin, amikacin, and limited computed tomography-guided needle aspiration

Am J Med. 1984 Sep;77(3):558-60. doi: 10.1016/0002-9343(84)90121-9.

Abstract

Hepatic abscesses are rarely encountered in disseminated Nocardia infections. Sulfonamides alone or trimethoprim/sulfamethoxazole is often efficacious in treating infections caused by Nocardia asteroides. In vitro resistance of N. asteroides to trimethoprim/sulfamethoxazole is occasionally present. The patient described in this report had disseminated nocardiosis initially manifesting as multiple subcapsular hepatic abscesses. In vitro susceptibility studies demonstrated resistance to trimethoprim/sulfamethoxazole. Subsequent treatment with ampicillin and amikacin in conjunction with computed tomography-guided needle aspiration of several of the hepatic abscesses, surgical drainage of a right pleural empyema, and eventual discontinuation of use of corticosteroids resulted in cure of the infection.

Publication types

  • Case Reports

MeSH terms

  • Amikacin / therapeutic use*
  • Ampicillin / therapeutic use*
  • Combined Modality Therapy
  • Drug Combinations / therapeutic use
  • Drug Therapy, Combination
  • Humans
  • Kanamycin / analogs & derivatives*
  • Liver Abscess / drug therapy
  • Liver Abscess / microbiology
  • Liver Abscess / therapy*
  • Male
  • Middle Aged
  • Nocardia Infections / drug therapy
  • Nocardia Infections / therapy*
  • Nocardia asteroides
  • Penicillin Resistance
  • Suction
  • Sulfamethoxazole / therapeutic use
  • Tomography, X-Ray Computed
  • Trimethoprim / therapeutic use
  • Trimethoprim, Sulfamethoxazole Drug Combination

Substances

  • Drug Combinations
  • Kanamycin
  • Ampicillin
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Amikacin
  • Trimethoprim
  • Sulfamethoxazole