Chronic renal insufficiency and Nocardia brasiliensis infection: A call for heightened vigilance and multidisciplinary management.

This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al, emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age, comorbidities, and immunocompromised populations. The study's strengths included its integration of immunological profiling and precision medicine, demonstrating that a tailored low-dose trimethoprim-sulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks. However, its limitations included a single-case design, reliance on phenotypic diagnostics, and the lack of information regarding comorbidity interactions. The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection. Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization, developing biomarkers for early detection, and conducting global epidemiological studies in endemic regions. This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.