Post renal transplant pulmonary nocardiosis - A case report

Abstract

Nocardiosis is a rare opportunistic infection caused by an aerobic actinomycete, producing either local or disseminated disease. It is a systemic infection that usually begins in the lungs and has high predilection for brain, skin and subcutaneous tissues. It commonly affects solid organ transplant recipients on immunosuppressive drugs. The incidence of nocardiosis in solid organ transplant recipients is about 0.6%. In India, nocardiosis was reported in 1.4% of renal transplant recipients. We report a case of pulmonary nocardiosis in a postrenal transplant recipient. Patient presented with features suggestive of pneumonia not responding to antibiotics. Initial sputum gram stain and AFB was negative. Chest radiograph showed right parahilar non-homogenous opacity, and CT chest revealed right parahilar, and subcarinal adenopathy. Bronchoscopy was done which showed purulent secretion from right 6th bronchial segment and AFB stain of broncho alveolar lavage fluid, showed weak acid fast filamentous bacteria, suggestive of nocardiosis. Patient was treated with antibiotics imipenem and co-trimoxazole. Patient responded well to treatment and pneumonia was resolved.