Nocardia brasiliensis infection mimicking juvenile idiopathic arthritis in a 4-year-old girl

Kapur, N., Adib, N. and Grimwood, K. (2013) Nocardia brasiliensis infection mimicking juvenile idiopathic arthritis in a 4-year-old girl. Pediatrics, 132 5: E1424-E1427. doi:10.1542/peds.2012-3086

Author Kapur, N.
Adib, N.
Grimwood, K.
Title Nocardia brasiliensis infection mimicking juvenile idiopathic arthritis in a 4-year-old girl
Journal name Pediatrics   Check publisher's open access policy
ISSN 0031-4005
Publication date 2013-11-01
Year available 2013
Sub-type Article (original research)
DOI 10.1542/peds.2012-3086
Open Access Status
Volume 132
Issue 5
Start page E1424
End page E1427
Total pages 4
Place of publication Elk Grove Village, IL, U.S.A.
Publisher American Academy of Pediatrics
Language eng
Subject 2735 Pediatrics, Perinatology, and Child Health
1201 Architecture
Abstract Nocardia are ubiquitous environmental saprophytes that cause pneumonia and disseminated disease in immunocompromised patients. They can also cause localized cutaneous and soft tissue infections in healthy people after direct percutaneous inoculation. Nocardia arthritis is rare in both forms of the disease. Here we present the first published case of a child with septic arthritis caused by N brasiliensis. Importantly, this otherwise well 4-year-old girl had no known history of trauma but presented with transient cutaneous lesions and a 6-week history of arthritis involving the right fourth digit proximal interphalangeal joint without accompanying fever or raised systemic inflammatory markers. She received a diagnosis of juvenile idiopathic arthritis and underwent antiinflammatory and immunosuppressant therapy. After 2 months she developed frank septic arthritis, which necessitated a surgical joint washout, from which an intraoperative swab grew N brasiliensis. The patient received 6 months of high-dose trimethoprim-sulfamethoxazole and remains well more than 4 years after treatment. This unusual case highlights the importance of considering an indolent infection from slow-growing organisms, including Nocardia, when diagnosing the oligoarthritis subtype of juvenile idiopathic arthritis. This is especially relevant when a single joint is involved and response to antiinflammatory therapy is suboptimal because antiinflammatory agents may mask evolving signs of infection. Pediatrics 2013;132:e1424-e1427. Copyright
Keyword Arthritis
Juvenile idiopathic arthritis
Oligoarthritis subtype
Septic arthritis
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status UQ

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