Solitary giant abscess extending from the left gluteal to thigh due to Nocardia cyriacigeorgica in an immunocompetent patient: a case report
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND: Nocardia cyriacigeorgica, a rare aerobic actinomycete, primarily infects immunocompromised hosts but is increasingly reported in immunocompetent individuals. Pulmonary involvement is its predominant manifestation; solitary giant abscesses are exceptionally rare in all patients. CASE PRESENTATION: A 92-year-old immunocompetent woman with coronary artery disease presented with acute left gluteofemoral swelling, pain, and fever (39.5 °C) persisting for 10 days. Symptoms progressed despite empirical antibiotics. Magnetic resonance imaging (MRI) revealed a multiloculated abscess spanning the left gluteal, hip, and proximal thigh compartments. Routine pus cultures were negative. Metagenomic next-generation sequencing (mNGS) of drainage fluid identified Nocardia cyriacigeorgica at 48 h, guiding a targeted culture that confirmed the diagnosis within a further 72 h. Antimicrobial Susceptibility Testing demonstrated susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX). Ultrasound-guided drainage and TMP-SMX therapy achieved complete clinical and radiological resolution within 6 weeks. CONCLUSION: This is the first reported case of an immunocompetent patient with a solitary giant Nocardia cyriacigeorgica abscess in the gluteofemoral region. mNGS facilitated rapid pathogen identification, guiding targeted culture and susceptibility testing. This approach establishes a diagnostic-therapeutic paradigm for early recognition and precision management of similar infections. CLINICAL TRIAL: Not applicable.
Source: BMC Infectious Diseases
Authors: Wei Li, Zhouyang Wang, Yang Li, Feng Zhang, Quankui Zhuang
Institution: Fuyang Second People's Hospital
Language: English
Subfield: Microbiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W4417506979