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Nocardia infection of a joint prosthesis complicating systemic lupus erythematosus

Service de Médecine Interne, Hôpital Tenon, 4 rue de la Chine, F-75970, Paris Cedex 20, France.Tel: (/33) (1) 56 01 66 14; Fax: (+33) (01) 70 82

H Man

Service de Médecine Interne, France

F Delisle

Laboratoire de Bactériologie, Hôpital Tenon, Paris, France

P M'Bappe

Laboratoire de Bactériologie, Hôpital Tenon, Paris, France

J-J Cocheton

Laboratoire de Bactériologie, Hôpital Tenon, Paris, France

The authors report the case of a 43-year-old woman suffering from severe systemic lupus erythematosus treated with long-term prednisone, who developed Nocardia nova infection on a hip prosthesis. Sepsis occurred about two years after an episode of pulmonary nocardiosis with the same Nocardia species, that was successfully treated by 12 months of antibiotics. A good outcome of the joint infection was observed in response to antibiotics and removal of the prosthesis.

Nocardiosis is a rare infection, acting as an opportunisticinfection, facilitated in the present case by systemic lupus erythematosus and chronic corticosteroid therapy. Nocardia infections mainly affect the lungs, skin and central nervous system; these last two sites are mostly due to haematogenous spread, a frequent event. Treatment is based on antibiotics, usually continued for 3 - 12 months, especially because of the risk of relapse. The imipenem - amikacin combination appears to be more effective than trimethoprim - sulfamethoxazole. To our knowledge, this is the first case report of Nocardia nova joint prosthesis infection also presenting as late septic spread of pulmonary nocardiosis, complicating corticosteroid-treated systemic lupus erythematosus.

Key Words: nocardiosis • recurrence • joint prosthesis • systemic lupus erythematosus • corticosteroid therapy

Lupus, Vol. 9, No. 4, 304-306 (2000)
DOI: 10.1191/096120300680198917


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