Imaging Pericardial Nocardiosis by Cardiac Magnetic Resonance

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A 72-year-old female renal transplant recipient was admitted with asthenia and low-grade fever. Two months earlier, she developed nodular pulmonary infiltrates (Figure 1), and microbiological examination of bronchoalveolar lavage fluid established the diagnosis of pulmonary nocardiosis. She had been taking ciprofloxacin and minocycline since that time. Physical examination was unremarkable, and the ECG revealed normal sinus rhythm with atrial bigeminy and no conduction abnormalities (Figure 2). Because of persistent fever, cerebral and thoracoabdominal computed tomography scans were performed and revealed multiple cystic lesions in the brain and mediastinum. Subcutaneous nodular lesions were also seen in the thoracoabdominal wall. Needle aspiration of one of the latter revealed gram-positive bacilli and grew Nocardia farcinica. Figure 1. Chest radiograph performed 2 months before admission, when pulmonary nocardiosis was diagnosed ( A ), showing right superior lobe nodular infiltrate (white arrows), which regressed on the chest radiograph performed on admission ( B ). The cardiothoracic index (black arrows) is increased because of …