Nocardia infection in SLE: A case series of three patients

Abstract

Objectives: Nocardia infections have been described in immunosuppressed patient including patients with systemic lupus erythematosus (SLE). There are only a few case series in patients with SLE. Thus we studied the clinical presentations, organ involvement, treatment and outcome of cases of nocardial infection in the SLE patients. Methods: Records of SLE patients who attended our rheumatology clinic in the last 25 years were reviewed and cases of nocardial infection were identified and data was collected from case records. Results: Three cases of nocardiosis were found in our lupus series, giving a prevalence of 0.2%. Brain involvement was seen in all 3, whereas pulmonary and subcutaneous abscess was found in two patients each. All patients were managed with antibiotics and one patient required surgical drainage. All recovered without any morbidity. Conclusion: Nocardial infection, though rare in SLE has a good outcome. Involvement of brain, skin and lung together in a patient with background of immunosuppression should raise a suspicion of nocardial infection.