SESSION TITLE: Complications of Thoracic InfectionsSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 01:35 pm - 02:35 pmINTRODUCTION: Nocardia is an anaerobic, gram-positive, weakly acid-fast bacteria that is found in fresh and saltwater, organic soil, and decaying vegetation [1]. We report a case of a patient with pulmonary nocardiosis post right upper lobectomy who was found to have been exposed to Nocardia through growing marijuana at his home greenhouse.CASE PRESENTATION: Our patient is a 36-year-old male who presented with sudden onset of shortness of breath and nonproductive cough. He was found to have a left-sided pneumothorax and bullous changes of the right lung apex. He underwent an interventional radiology-guided left-sided chest tube placement, however, continued to have an air leak in the pleurovac and subsequently underwent Video-assisted thoracoscopic surgery (VATS) for left upper lobe bronchopleural fistula with mechanical and chemical pleurodesis with resection of the left apical bulla. Work-up for alpha-1 antitrypsin, cystic fibrosis, cocci, and HIV, all resulted negative. The patient was discharged after showing signs of recovery post-procedure. 10 days later he presented again, this time with increasing shortness of breath, chills, and cough. Chest imaging resulted in a right upper lobe fluid collection. He was started on cefepime and vancomycin. Interventional pulmonology was consulted, and he underwent bronchoscopy with a biopsy, which showed a right upper lobe cavity, and transbronchial biopsies were performed. Workup of Bronchoalveolar lavage was negative for Aspergillus, Nocardia, acid-fast bacteria, eosinophils, and lymphocytes. He was then continued on 4 weeks of Augmentin. A follow-up visit to the cardiothoracic surgery clinic showed persistent right upper lung cavity with fluid level worsening despite the antibiotics. They considered a right upper lobe lobectomy and the patient underwent VATS upper lobectomy. Postprocedure the cyst fluid culture grew Nocardia nova. Bactrim was started. Upon detailed interview, the patient shared about growing marijuana at home. He told that he has a greenhouse tent at his home in which he has been growing marijuana for his consumption. He was instructed to use N95, to avoid exposure and to follow up with an interstitial lung disease specialist.DISCUSSION: The inhalation route is considered the major source of nocardial infection in the United States with the highest number of infections seen in the Southwest, where the dry, warm, dusty and windy conditions favor the spread of fragmented nocardial cells [2]. Inhaled marijuana itself increases the risk of pulmonary infections secondary to the contamination of its leaves with fungal pathogens like Aspergillosis [3]. Domestically growing marijuana without proper precautions can pose a risk of acquiring pulmonary Nocardiosis and extensive exposure history should always be taken into account in these patients.CONCLUSIONS: Soil exposure from growing marijuana at home increase the risk of pulmonary nocardiosis.Reference #1: Wilson JW. Nocardiosis: updates and clinical overview. In Mayo Clinic Proceedings 2012 Apr 1 (Vol. 87, No. 4, pp. 403-407). Elsevier.Reference #2: Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. Journal of clinical microbiology. 2003 Oct;41(10):4497-501Reference #3: Ribeiro L, Ind PW. Marijuana and the lung: hysteria or cause for concern?. Breathe. 2018 Sep 1;14(3):196-205]DISCLOSURES: No relevant relationships by Muhammad ArifNo relevant relationships by Ross BremnerNo relevant relationships by Abdul Rahman HalawaNo relevant relationships by Jessica JacobNo relevant relationships by Moiz JavedNo relevant relationships by Luis MezaNo relevant relationships by Ali SaeedNo relevant relationships by Anthony Vaccarello SESSION TITLE: Complications of Thoracic Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Nocardia is an anaerobic, gram-positive, weakly acid-fast bacteria that is found in fresh and saltwater, organic soil, and decaying vegetation [1]. We report a case of a patient with pulmonary nocardiosis post right upper lobectomy who was found to have been exposed to Nocardia through growing marijuana at his home greenhouse. CASE PRESENTATION: Our patient is a 36-year-old male who presented with sudden onset of shortness of breath and nonproductive cough. He was found to have a left-sided pneumothorax and bullous changes of the right lung apex. He underwent an interventional radiology-guided left-sided chest tube placement, however, continued to have an air leak in the pleurovac and subsequently underwent Video-assisted thoracoscopic surgery (VATS) for left upper lobe bronchopleural fistula with mechanical and chemical pleurodesis with resection of the left apical bulla. Work-up for alpha-1 antitrypsin, cystic fibrosis, cocci, and HIV, all resulted negative. The patient was discharged after showing signs of recovery post-procedure. 10 days later he presented again, this time with increasing shortness of breath, chills, and cough. Chest imaging resulted in a right upper lobe fluid collection. He was started on cefepime and vancomycin. Interventional pulmonology was consulted, and he underwent bronchoscopy with a biopsy, which showed a right upper lobe cavity, and transbronchial biopsies were performed. Workup of Bronchoalveolar lavage was negative for Aspergillus, Nocardia, acid-fast bacteria, eosinophils, and lymphocytes. He was then continued on 4 weeks of Augmentin. A follow-up visit to the cardiothoracic surgery clinic showed persistent right upper lung cavity with fluid level worsening despite the antibiotics. They considered a right upper lobe lobectomy and the patient underwent VATS upper lobectomy. Postprocedure the cyst fluid culture grew Nocardia nova. Bactrim was started. Upon detailed interview, the patient shared about growing marijuana at home. He told that he has a greenhouse tent at his home in which he has been growing marijuana for his consumption. He was instructed to use N95, to avoid exposure and to follow up with an interstitial lung disease specialist. DISCUSSION: The inhalation route is considered the major source of nocardial infection in the United States with the highest number of infections seen in the Southwest, where the dry, warm, dusty and windy conditions favor the spread of fragmented nocardial cells [2]. Inhaled marijuana itself increases the risk of pulmonary infections secondary to the contamination of its leaves with fungal pathogens like Aspergillosis [3]. Domestically growing marijuana without proper precautions can pose a risk of acquiring pulmonary Nocardiosis and extensive exposure history should always be taken into account in these patients. CONCLUSIONS: Soil exposure from growing marijuana at home increase the risk of pulmonary nocardiosis. Reference #1: Wilson JW. Nocardiosis: updates and clinical overview. In Mayo Clinic Proceedings 2012 Apr 1 (Vol. 87, No. 4, pp. 403-407). Elsevier. Reference #2: Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. Journal of clinical microbiology. 2003 Oct;41(10):4497-501 Reference #3: Ribeiro L, Ind PW. Marijuana and the lung: hysteria or cause for concern?. Breathe. 2018 Sep 1;14(3):196-205] DISCLOSURES: No relevant relationships by Muhammad Arif No relevant relationships by Ross Bremner No relevant relationships by Abdul Rahman Halawa No relevant relationships by Jessica Jacob No relevant relationships by Moiz Javed No relevant relationships by Luis Meza No relevant relationships by Ali Saeed No relevant relationships by Anthony Vaccarello