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Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report

Nadim Cassir12, Matthieu Million12, Remy Noudel3, Michel Drancourt1 and Philippe Brouqui124*

Author Affiliations

1 Unité de Recherchesur les Maladies InfectieusesTropicales et Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, InstitutHospitalo-UniversitaireMéditerranée-Infection, Aix-Marseille-Université, Marseille, France

2 Service de Maladies Infectieuses et Tropicales, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France

3 Service de Neurochirurgie, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France

4 InstitutHospitalo-Universitaire en Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Chemin des Bourrelys, 13915, Marseille, cedex 20, France

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Journal of Medical Case Reports 2013, 7:103  doi:10.1186/1752-1947-7-103

Published: 11 April 2013



Nocardial infections, although rare, are challenging for clinicians to treat. Recent contradictory reports of sulfonamide resistance have raised concerns about using this drug to treat nocardial infections.

Case presentation

A 62-year-old immunocompetent Caucasian woman showed disseminated pulmonary nodules and a brain abscess by chest computed tomography and brain magnetic resonance imaging, respectively. Multidrug-resistant Nocardia wallacei was cultured from a stereotactic brain biopsy and confirmed by 16S ribosomal ribonucleic acid gene sequencing. After the first-line treatment failed, a long course of trimethoprim-sulfamethoxazole was prescribed with no evidence of recurrence. To the best of our knowledge, this is the first report of a Nocardia wallacei disseminated infection in an immunocompetent patient, and it is the first detailed description of successful treatment with trimethoprim-sulfamethoxazole despite the resistance observed in vitro.


Species identification of clinical isolates is critical for diagnosis, a prediction of antimicrobial susceptibility and epidemiological tracking. In the case of Nocardia wallacei, the clinical outcome suggests that sulfonamides can be used for treatment despite ambiguous results from in vitro susceptibility tests.

Neurosurgery; Nocardia wallacei; Sulfonamide resistance