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dc.contributor.authorKapur, N
dc.contributor.authorAdib, N
dc.contributor.authorGrimwood, K
dc.date.accessioned2017-05-03T13:14:26Z
dc.date.available2017-05-03T13:14:26Z
dc.date.issued2013
dc.date.modified2014-06-12T23:44:44Z
dc.identifier.issn0031-4005
dc.identifier.doi10.1542/peds.2012-3086
dc.identifier.urihttp://hdl.handle.net/10072/60168
dc.description.abstractNocardia are ubiquitous environmental saprophytes that cause pneumonia and disseminated disease in immunocompromised patients. They can also cause localized cutaneous and soft tissue infections in healthy people after direct percutaneous inoculation. Nocardia arthritis is rare in both forms of the disease. Here we present the first published case of a child with septic arthritis caused by N brasiliensis. Importantly, this otherwise well 4-year-old girl had no known history of trauma but presented with transient cutaneous lesions and a 6-week history of arthritis involving the right fourth digit proximal interphalangeal joint without accompanying fever or raised systemic inflammatory markers. She received a diagnosis of juvenile idiopathic arthritis and underwent antiinflammatory and immunosuppressant therapy. After 2 months she developed frank septic arthritis, which necessitated a surgical joint washout, from which an intraoperative swab grew N brasiliensis. The patient received 6 months of high-dose trimethoprim-sulfamethoxazole and remains well more than 4 years after treatment. This unusual case highlights the importance of considering an indolent infection from slow-growing organisms, including Nocardia, when diagnosing the oligoarthritis subtype of juvenile idiopathic arthritis. This is especially relevant when a single joint is involved and response to antiinflammatory therapy is suboptimal because antiinflammatory agents may mask evolving signs of infection.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.format.extent620444 bytes
dc.format.mimetypeapplication/pdf
dc.languageEnglish
dc.language.isoeng
dc.publisherAmerican Academy of Pediatrics
dc.publisher.placeUnited States
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrome1424
dc.relation.ispartofpagetoe1427
dc.relation.ispartofjournalPediatrics
dc.relation.ispartofvolume132
dc.rights.retentionY
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchPsychology
dc.subject.fieldofresearchcode32
dc.subject.fieldofresearchcode52
dc.titleNocardia brasiliensis Infection Mimicking Juvenile Idiopathic Arthritis in a 4-Year-Old Girl
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.rights.copyright© 2013 American Academy of Pediatrics. The attached file is reproduced here in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version.
gro.hasfulltextFull Text
gro.griffith.authorGrimwood, Keith


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