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Nocardia cyriacigeorgica: First case of endocarditis with disseminated soft tissue infection and a review of the literature

¹ University of Leeds and Leeds Teaching Hospitals NHS Trust;

² Leeds Teaching Hospitals NHS Trust;

³ Harrogate and District Hospital

⁴ E-mail: nigel.weightman{at}hdft.nhs.uk

Received April 6, 2009
Accepted September 24, 2009

Nocardia cyriacigeorgica is a common environmental organism. The organism has been isolated from clinical samples in Europe, Asia and North America, predominantly from respiratory samples but from several other sites. We present a case report of an 85 year old female patient in the UK who was found to have a multi-focal soft tissue infection from which N. cyriacigeorgica was isolated. She had a background history of chronic obstructive pulmonary disease and corticosteroid use for polymyalgia rheumatica. During the course of her treatment echocardiography showed the presence of a mobile heart mass attached to a valve leaflet, a major Dukes criterion for endocarditis. We suggest that in cases of disseminated Nocardia infection, endocarditis should be excluded, particularly in cases failing to respond to treatment. We also review the previous reports of both N. cyriacigeorgica infection and of endocarditis due to Nocardia species and related genera.