{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:36:42Z","timestamp":1787063802630,"version":"build-2736575974"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"\n Background<\/jats:title>\n Optimal antimicrobial strategies for disseminated nocardiosis with central nervous system (CNS) involvement remain poorly defined, particularly regarding trimethoprim-sulfamethoxazole (TMP-SMX) dosing in immunocompromised patients with severe drug intolerance.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This observational case study analyzed the clinical course and pharmacological management of a 55-year-old male gold miner with pneumoconiosis and chronic corticosteroid use who developed\n Nocardia farcinica<\/jats:italic>\n brain abscess. Diagnosis was established via metagenomic next-generation sequencing (mNGS) and phenotypic culture. An individualized antimicrobial regimen was designed based on toxicity monitoring.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Diagnosis of\n N. farcinica<\/jats:italic>\n was confirmed by mNGS within 48\u00a0h. The patient initially failed empirical meropenem but responded to combination therapy with imipenem, amikacin, and TMP-SMX. Due to grade III gastrointestinal toxicity (CTCAE v5.0), TMP-SMX was de-escalated from 15\u00a0mg\u00b7kg\n \u22121<\/jats:sup>\n \u00b7d\n \u22121<\/jats:sup>\n \u201311.25\u00a0mg\u00b7kg\n \u22121<\/jats:sup>\n \u00b7d\n \u22121<\/jats:sup>\n , with maintenance at 7.5\u00a0mg\u00b7kg\n \u22121<\/jats:sup>\n \u00b7d\n \u22121<\/jats:sup>\n . Clinical improvement was observed at Day 120, though durable cure remains unconfirmed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In extreme circumstances of severe dose-limiting toxicity, temporary TMP-SMX dose reduction with intensive monitoring may be feasible as a bridge to complete guideline-concordant therapy, though this approach falls below current recommendations and requires robust therapeutic drug monitoring. Species-directed antimicrobial selection and early molecular diagnosis facilitated initial clinical resolution in this high-risk immunocompromised host.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fphar.2026.1805920","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:10:45Z","timestamp":1775707845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Toxicity-guided dose modification for disseminated Nocardia farcinica brain abscess in a patient with pneumoconiosis: a brief research report"],"prefix":"10.3389","volume":"17","author":[{"given":"Hui Juan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, 363 Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang Fen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, 363 Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao Yue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, 363 Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, 363 Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.cmi.2023.08.016","article-title":"European society of clinical microbiology and infectious diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen","year":"2024","journal-title":"Clin. Microbiology Infection The Official Publication Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1093\/jac\/dkad236","article-title":"Phenotypic and genotypic analysis of antimicrobial resistance in nocardia species","volume":"78","author":"Hershko","year":"2023","journal-title":"J. Antimicrobial Chemotherapy"},{"key":"B3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/s00203-023-03799-z","article-title":"Exploring Nocardia's ecological spectrum and novel therapeutic frontiers through whole-genome sequencing: unraveling drug resistance and virulence factors","volume":"206","author":"Nathar","year":"2024","journal-title":"Arch. 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Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s15010-024-02323-9","article-title":"Trimethoprim-sulfamethoxazole dosing and outcomes of pulmonary nocardiosis","volume":"53","author":"Yetmar","year":"2025","journal-title":"Infection"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1805920\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:10:53Z","timestamp":1775707853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1805920\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":8,"alternative-id":["10.3389\/fphar.2026.1805920"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1805920","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"article-number":"1805920"}}