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CASE REPORT article

Front. Med.
Sec. Pulmonary Medicine
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1425655

Case report: metagenomic next-generation sequencing for the diagnosis of rare Nocardia aobensis infection in a patient with immune thrombocytopenia

Provisionally accepted
Xiaocui Liang Xiaocui Liang 1Xiaoyu Liu Xiaoyu Liu 2Zhimin Huang Zhimin Huang 2Fei Qiu Fei Qiu 2Yini Jiang Yini Jiang 2Chunhong Li Chunhong Li 1Zhenfeng Deng Zhenfeng Deng 1Jinyu Wu Jinyu Wu 2*
  • 1 Guangxi KingMed Diagnostics Co., Ltd, Nanning, China
  • 2 First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi Zhuang Region, China

The final, formatted version of the article will be published soon.

    Background: Nocardiosis poses a diagnostic challenge due to its rarity in clinical practice, non-specific clinical symptoms and imaging features, and the limitations of traditional detection methods. Nocardia aobensis (N. aobensis) is rarely detected in clinical samples. Metagenomic next-generation sequencing (mNGS) offers significant advantages over traditional methods for rapid and accurate diagnosis of infectious diseases, especially for rare pathogens. Case presentation: A 52-year-old woman with a history of immune thrombocytopenia for over two years was hospitalized for recurrent fever and cough lasting for 10 days. Her initial diagnosis on admission was community-acquired pneumonia, based on chest computed tomography findings of lung inflammation lesion. Empirical treatment with moxifloxacin and trimethoprim-sulfamethoxazole (TMP-SMZ) was initiated. However, her condition failed to improve significantly even after one week of treatment. Bronchoalveolar lavage fluid (BALF) subjected to mNGS revealed the presence of N. aobensis, resulting in a diagnosis of pulmonary nocardiosis caused by N. aobensis. This diagnosis was also supported by Sanger sequencing of the BALF. After adjusting the antibiotic regimen to include TMP-SMZ in combination with imipenem, the patient's condition significantly improved. She was finally discharged with instructions to continue oral treatment with TMP-SMZ and linezolid for six months. The patient's first follow-up one month after discharge showed good treatment outcomes but with obvious side effects of the drugs. Consequently, the antibiotic regimen was changed to doxycycline, and the patient continued to improve. Conclusions: We report the first detailed case of pulmonary nocardiosis caused by N. aobensis diagnosed by mNGS. mNGS could be an effective method that facilitates early diagnosis and timely decision-making for the treatment of nocardiosis, especially in cases that involve rare pathogens.

    Keywords: Nocardia aobensis, Nocardiosis, metagenomic next-generation sequencing, diagnosis, case report

    Received: 30 Apr 2024; Accepted: 21 Oct 2024.

    Copyright: © 2024 Liang, Liu, Huang, Qiu, Jiang, Li, Deng and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jinyu Wu, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530023, Guangxi Zhuang Region, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.