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Background <p><i>Nocardia cyriacigeorgica</i>, 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.</p> Case presentation <p>A 92-year-old immunocompetent woman with coronary artery disease presented with acute left gluteofemoral swelling, pain, and fever (39.5&#xa0;°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 <i>Nocardia cyriacigeorgica</i> at 48&#xa0;h, guiding a targeted culture that confirmed the diagnosis within a further 72&#xa0;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.</p> Conclusion <p>This is the first reported case of an immunocompetent patient with a solitary giant <i>Nocardia cyriacigeorgica</i> 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.</p> Clinical trial <p>Not applicable.</p>

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Solitary giant abscess extending from the left gluteal to thigh due to Nocardia cyriacigeorgica in an immunocompetent patient: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月19日

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  • Wei Li,
  • Zhouyang Wang,
  • Yang Li,
  • Feng Zhang,
  • Quankui Zhuang

摘要

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.