Multiple abscesses in a patient with membranous glomerulonephritis

A 50 year old male presented with right palm swelling, low back pain, and cough since 2 weeks. History was notable for membranous glomerulonephritis since 10 years on steroids. Examination revealed a fluctuant right palm swelling and a fluctuant anterior abdominal wall swelling. The chest radiograph showed left lower lobe homogenous infiltrate. MRI spine showed Paravertebral abscess in lumbar region.

Aspirate from anterior abdominal wall was aspirated. Gram positive filamentous form were seen on the gram stain. Nocardia spp. were isolated on pus culture.

MRI brain showed enhancing nodular meningeal lesions. However no focal neurologic deficits or meningeal signs were noted Abdominal wall abscess was drained with a pigtail catheter. CT guided aspiration of lumbar abscess was performed. Imipenem, TMP-SMX and Amikacin were started. The prednisolone dose was reduced.

Disseminated Nocardiosis