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      A case of nocardiosis in a patient with ulcerative colitis on chronic corticosteroids, infliximab, and upadacitinib

      case-report

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          Abstract

          Key Clinical Message

          Immunosuppression, malnutrition, and underlying infection can unmask obscure infections which can be challenging to identify. Early diagnosis and treatment of infections in immunosuppressed patients are essential due to high morbidity and mortality.

          Abstract

          The immunosuppressive effects of treatment for ulcerative colitis (UC), including chronic corticosteroids, anti‐TNF agents, and JAK inhibitors, can impact the spread of latent or obscure infections. Clinicians should have a low threshold for pursuing aggressive diagnostic and therapeutic intervention in patients who show signs of clinical deterioration while on immunosuppressing medications. Our unique case highlights an immunosuppressed patient with UC who developed Nocardiosis after initiation of upadacitinib while hospitalized for concurrent UC flare and Clostridium difficile infection.

          Abstract

          We report a complex infection of Nocardiosis and C. difficile colitis that developed in a patient with ulcerative colitis in the setting of chronic immunosuppression and malnutrition.

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          Efficacy of Upadacitinib in a Randomized Trial of Patients With Active Ulcerative Colitis

          William J Sandborn, Subrata Ghosh, Julián Panés … (2020)
          Article 0 comments Cited 96 times – based on 0 reviews     Review now
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            Nocardia infections among immunomodulated inflammatory bowel disease patients: A review.

            Nuno Rocha-Pereira, Cândida Abreu, Fernando Magro … (2015)
            Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
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              Nocardia and Aspergillus Coinfection in a Patient with Ulcerative Colitis during Golimumab Therapy.

              Maite Alonso-Sierra, Marta Calvo, Yago González-Lama (2016)
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                Author and article information

                Contributors
                Benjamin M. Moy:
                ORCID: https://orcid.org/0000-0002-8726-7132
                bmmoy@med.umich.edu
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 16 May 2023
                Publication date Collection: May 2023
                Volume: 11
                Issue: 5 ( doiID: 10.1002/ccr3.v11.5 )
                Electronic Location Identifier: e7362
                Affiliations
                [ 1 ] University of Michigan Medical School Ann Arbor Michigan USA
                [ 2 ] Division of Gastroenterology and Hepatology, Department of Internal Medicine Michigan Medicine Ann Arbor Michigan USA
                Author notes
                [*] [* ] Correspondence

                Benjamin M. Moy, Michigan Medicine‐University of Michigan Hospitals, 3912 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.

                Email: bmmoy@ 123456med.umich.edu

                Author information
                https://orcid.org/0000-0002-8726-7132
                Article
                Publisher ID: CCR37362 Other ID: CCR3-2023-04-0645.R1
                DOI: 10.1002/ccr3.7362
                PMC ID: 10188892
                PubMed ID: 37207089
                SO-VID: 8ef4930b-5063-49f8-b5b7-6de11ce3c4bc
                Copyright © © 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 25 April 2023
                Date received : 06 April 2023
                Date accepted : 04 May 2023
                Page count
                Figures: 2, Tables: 0, Pages: 4, Words: 1923
                Categories
                Subject: Case Report
                Subject: Case Report
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.8 mode:remove_FC converted:16.05.2023

                Keywords: crohns,ibd,immunosuppression,jak inhibitors,nocardia
                Data availability:
                Keywords: crohns, ibd, immunosuppression, jak inhibitors, nocardia

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