A Rare Case of Recurrent IgG-4 Pulmonary Pseudotumor

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: We present a rare case of multiple breast abscesses secondary to Nocardia cyriacigeorgica in an immunocompetent patient.

Case Report: A 37-year-old healthy female presented to the emergency department with left breast pain, fever, and chills. She had no recent history of childbirth or breastfeeding. She reported being in a hot tub several weeks prior to the pain and swelling in her breast and had recently swum in a local river. Physical exam was abnormal for an area of induration on her left medial breast that was erythematous and painful. There was no nipple discharge, mass, or inverted nipple. She was empirically prescribed cefepime and vancomycin. An ultrasound revealed a complex fluid collection measuring 3.5 x 0.6 cm. Purulent fluid was aspirated via ultrasound aspiration, and patient felt improved. She was discharged on cefdinir and linezolid. Tissue culture and body culture grew Nocardia cyriacigeorgica. Unfortunately, throughout the course of a year, the patient had 4 recurrent episodes of breast abscess symptoms. Repeat ultrasound guided aspiration continued to reveal the presence of Nocardia cyriacigeorgica. Patient has been treated for weeks with a variety of antibiotics including ceftriaxone, linezolid, trimethoprim/sulfamethoxazole, and meropenem.

Discussion: To our knowledge, this is the first case of a breast abscess secondary to Nocardia cyriacigeorgica. Nocardia cyriacigeorgica was first reported as pathogen in 2007 in a heart transplant patient. Similar to other nocardia infections, it has been reported to cause pulmonary infections and brain abscesses especially in immunosuppressed patients. This case of Nocardia cyriacigeorgica was diagnosed via MALDI-TOF MS (matrix-assisted laser desorption ionization—time of flight mass spectrometry system). Nocardia is ubiquitously found in the environment such as the soil and water. Specifically, Nocardia cyriacigeorgica has been linked to polluted water exposure. Nocardia exposure often occur via inhalation, although cutaneous exposures have also been documented. Similarly, Nocardia breast infections also occur via dissemination post-inhalation or may be through cutaneous exposure. In terms of antibiotic therapy, the hallmark of therapy versus nocardia species has been sulfonamide based therapy. Duration may also depend on both severity of disease and degree of immunosuppression. This patient still had drainable lesions at six months, thus the decision was made to extend therapy to 12 months. Although nocardia species are frequently linked to immunosuppression, this organism should be considered in patients with potential environmental exposure. Definitive treatment should include sufficient drainage and a prolonged antibiotic course.

Volume

212

Issue

Suppl 1

First Page

S3346

Last Page

S3346

Comments

American Thoracic Society International Conference, May 15-20, 2026, Orlando, FL

DOI

10.1093/ajrccm/aamag162.4002

ISSN

1073-449X

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