{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T01:39:03Z","timestamp":1778031543172,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,3]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Nocardiosis is a rare infection in patients with myasthenia gravis (MG). We identified three cases of MG admitted with nocardiosis in our unit. We performed systematic literature search of previous publications and identified 18 patients. This paper presents three patients and reviews the clinical characteristics of 21 patients. The first case was a 69-year-old woman with thymomatous MG who presented with pustules and left lower limb pain. Evaluation showed osteomyelitis of the pubic ramus and ileopsoas abscess. The second case was a 54-year-old man who presented in myasthenic crisis due to pulmonary nocardiosis. The third case was a 48-year-old man with thymomatous MG who presented with lung abscess. All of them recovered completely after treatment with co-trimoxazole. Analysis of the 21 patients identified four risk factors for nocardiosis in MG: elderly men; thymoma; immunosuppressant medication, mainly steroid therapy; and pre-existing lung disease. Lungs was the most common site of infection. Suppurative disease was common manifestation regardless of organ involved. Clinical course is not unfavourable.<\/jats:p>","DOI":"10.1136\/bcr-2020-237208","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T17:46:46Z","timestamp":1609436806000},"page":"e237208","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Nocardiosis\u2014an uncommon infection in patients with myasthenia gravis: report of three cases and review of literature"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4805-6252","authenticated-orcid":false,"given":"Y","family":"Muralidhar Reddy","sequence":"first","affiliation":[{"name":"Neurology, CARE Hospitals - Banjara Hills, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subhendu","family":"Parida","sequence":"additional","affiliation":[{"name":"Neuroradiology, CARE Hospitals - Banjara Hills, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam K","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Neurology, CARE Hospitals - Banjara Hills, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jagarlapudi MK","family":"Murthy","sequence":"additional","affiliation":[{"name":"Neurology, CARE Hospitals - Banjara Hills, Hyderabad, Telangana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"key":"2025082712501876000_13.12.e237208.1","first-page":"259","article-title":"Clinical and laboratory features of the Nocardia spp","volume":"19","author":"Brown-Elliott","year":"2006","journal-title":"Based on Current Molecular Taxonomy Clinical Microbiology Reviews"},{"key":"2025082712501876000_13.12.e237208.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1201-9712(03)90102-0"},{"key":"2025082712501876000_13.12.e237208.3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.coi.2017.07.006","article-title":"Pathophysiology and immunological profile of myasthenia gravis and its subgroups","volume":"49","author":"Romi","year":"2017","journal-title":"Curr Opin Immunol"},{"key":"2025082712501876000_13.12.e237208.4","doi-asserted-by":"crossref","DOI":"10.1016\/j.chest.2019.08.671","article-title":"Pulmonary nocardiosis in the differential diagnosis for hypoxia with myasthenia gravis","volume":"156","author":"Tholany","year":"2019","journal-title":"Chest"},{"key":"2025082712501876000_13.12.e237208.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-019-1482-4","article-title":"A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review","volume":"19","author":"Wang","year":"2019","journal-title":"BMC Neurol"},{"key":"2025082712501876000_13.12.e237208.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.idcr.2018.e00422","article-title":"Nocardia paucivorans brain abscess. Clinical and microbiological characteristics","volume":"13","author":"Aliaga","year":"2018","journal-title":"IDCases"},{"key":"2025082712501876000_13.12.e237208.7","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-205262"},{"key":"2025082712501876000_13.12.e237208.8","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.amjmed.2015.03.002","article-title":"It took a village: good's syndrome","volume":"128","author":"Wargo","year":"2015","journal-title":"Am J Med"},{"key":"2025082712501876000_13.12.e237208.9","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-210264"},{"key":"2025082712501876000_13.12.e237208.10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4172\/2329-9541.1000118","article-title":"Nocardial infections: an Under-Diagnosed malady of immunocompromised hosts","volume":"02","author":"Jain","year":"2013","journal-title":"J Immunol Tech Infect Dis"},{"key":"2025082712501876000_13.12.e237208.11","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000001671","article-title":"Nocardia arthritis: 3 cases and literature review","volume":"94","author":"Chaussade","year":"2015","journal-title":"Medicine"},{"key":"2025082712501876000_13.12.e237208.12","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.84.14_supplement.P2.332","article-title":"Robert Altman nocardial intramedullary abscess; a case report and review of literature (P2.332)","volume":"84","author":"Lapointe","year":"2015","journal-title":"Neurology"},{"key":"2025082712501876000_13.12.e237208.13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/2384-5147.129322","article-title":"Habib Ag disseminated norcardial infection in a patient with myasthenia gravis on prolonged steroid therapy: a case report","volume":"1","author":"Farouq","year":"2014","journal-title":"Sub-Saharan African Journal of Medicine"},{"key":"2025082712501876000_13.12.e237208.14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5348\/ijcri-2013-01-249-CR-3","article-title":"Multiple nocardial brain abscesses in an immunocompromised patient with myasthenia gravis","volume":"4","author":"Shaikh","year":"2013","journal-title":"International Journal of Case Reports and Images"},{"key":"2025082712501876000_13.12.e237208.15","doi-asserted-by":"crossref","DOI":"10.1007\/s11606-013-2445-x","article-title":"Leg pain in a patient with myasthenia gravis","volume":"28","author":"Patel","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2025082712501876000_13.12.e237208.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10156-011-0315-1"},{"key":"2025082712501876000_13.12.e237208.17","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/325767"},{"key":"2025082712501876000_13.12.e237208.18","first-page":"97","article-title":"Pleuropulmonary nocardiosis in an immunocompromised patient","volume":"52","author":"Parhar","year":"2010","journal-title":"Bombay Hosp J"},{"key":"2025082712501876000_13.12.e237208.19","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-007-9011-1"},{"key":"2025082712501876000_13.12.e237208.20","first-page":"137","article-title":"Multiple abscesses due to Nocardia asteroides in a patient on steroids and azathioprine","volume":"12","author":"Bashir","year":"2005","journal-title":"JK practitioner"},{"key":"2025082712501876000_13.12.e237208.21","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3346\/jkms.2002.17.2.279","article-title":"Reactive cutaneous cytophagocytosis in nocardiosis","volume":"17","author":"Kim","year":"2002","journal-title":"J Korean Med Sci"},{"key":"2025082712501876000_13.12.e237208.22","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1007\/s00415-018-8751-9","article-title":"Myasthenia gravis and infectious disease","volume":"265","author":"Gilhus","year":"2018","journal-title":"J Neurol"},{"key":"2025082712501876000_13.12.e237208.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2011.12.022"},{"key":"2025082712501876000_13.12.e237208.24","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ijid.2020.01.011","article-title":"Nocardia bacteremia: a single-center retrospective review and a systematic review of the literature","volume":"92","author":"Williams","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2025082712501876000_13.12.e237208.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2011.11.016"},{"key":"2025082712501876000_13.12.e237208.26","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01531-13"},{"key":"2025082712501876000_13.12.e237208.27","doi-asserted-by":"crossref","unstructured":"Sorrell TC , Mitchell DH , Iredell JR , et al . Nocardia species. In: Bennett J , Dolin R , Blaser M , et al , eds. Mandell, Douglas, and Bennett\u2019s principles and practice of infectious diseases. 8th edn. Philadelphia: Saunders, 2015: 2853\u201363.","DOI":"10.1016\/B978-1-4557-4801-3.00255-1"},{"key":"2025082712501876000_13.12.e237208.28","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000012"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237208","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:50:23Z","timestamp":1756324223000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":28,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,31]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bcr-2020-237208"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237208","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}