Case report of pulmonary nocardiosis in a patient of right renal transplantation

Nocardiosis results from infection with bacteria of genus Nocardia, which are saprophytic aerobic actinomycetes that commonly reside in soil relatively and are inactive on standard biochemical tests. Pulmonary and systemic nocardiosis is common in adult males, almost all being sporadic, common in tuberculosis endemic regions and usually seen in individuals with deficient cell mediated immunity. It may present as pneumonia, empyema, pericarditis, mediastinitis, laryngitis, peritonitis, and meningitis. Diagnosed with sputum or pus for branching beaded gram positive filaments which are 1 micron meter wide and 50 micron meter long.A male immunocompromised patient presented with respiratory symptoms. Patient was evaluated elsewhere and received multiple courses of antibiotics. On admission in our facility HRCT thorax followed by fibre optic bronchoscopy was done. Bronchoalveolar lavage was sent for microbiological analysis.  Acid-fast in kinyoun and Ziehl Neelsen stain came positive for Nocardia and was managed with trimethoprim- sulfamethoxazole which is the treatment of choice.