Nocardia asteroides infection in a patient with Systemic Lupus Erythematosus

Nocardia asteroides infection are unusually observed in sistemic Lupus erit hematous (SLE) patients. They are generally associated to steroidal and imm unosuppressive therapy. We report a 24 years old female with SLE diagnosed in 1994 who developed a severe preeclampsia in her first pregnancy requirin g emergency caesarean section. Pst partum acute renal failure and type IV l upus nephropathy were treated with hemodialysis, metilprednisolone, cycloph osphamide and prednisone. Three months later, while she was receiving the f ourth cyclophosphamide dose, she presented with a pleuro pneumonia and occi pital abscess, both caused by Nocardia asteroides. She was treated with cot rimoxazole + cefixime and pleural decortication was required. Five months l ater, she developed Meningitis caused by Nocardia asteroides and hydrocepha lus. She was treated with ceftriaxone, vancomycin, cotrimoxazole and ventri cular shunting procedure. Two months later, a retroperitoneal abscess was d iagnosed and surgically drained but the patient died, due to a methicillin- resistant Staphylococcus aureus septicemia.