Nocardia osteomyelitis and epidural abscess in the nonimmunosuppressed host

ABSTRACT

We present a case of invasive nocardiosis in a nonimmunosuppressed host with pulmonary and neurosurgical complications, treated successfully with extensive surgical debridement and longterm antibiotic therapy. No underlying neoplasm or cellular or humoral immune defect was detected. The Cleveland Clinic’s experience with nocardiosis from 1967-1982 is reviewed. This review exemplifies the well-described augmented risk of Nocardia infection in the immunosuppressed host with a history of prolonged antibiotic, corticosteroid, or cytotoxic therapy, along with malignancy and cellular immunity dysfunction. The spectrum of invasive pulmonary nocardiosis in the nonimmunosuppressed patient should be recognized so as to understand the natural history and prognosis of this potentially lethal infection.