SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary nocardiosis is generally regarded as a rare infectious disease typically affecting immunocompromised individuals. However, one third of cases present in immunocompetent patients [1]. There is an increasing number of cases reported in individuals with bronchiectasis. We present an immunocompetent patient who presented with bronchiectasis due to pulmonary nocardiosis. CASE PRESENTATION: This case describes a 22-year-old male with no significant past medical history. He initially presented with fevers, chronic productive cough, and exertional dyspnea for approximately one year. Computed tomography (CT) of the chest demonstrated right middle lobe cicatricial atelectasis with mucoid bronchiectasis, lingular cylindrical bronchiectasis, basilar predominant tree-in-bud opacities, and mediastinal lymphadenopathy (Figure 1A-C). These findings prompted diagnostic bronchoscopic evaluation that revealed dilated bronchiectatic airways with copious tan sections in right middle and lower lobes. Additionally, spirometry was obtained, demonstrating moderate obstructive defect. Extensive evaluation for immunodeficiencies, pulmonary ciliary dyskinesia, and autoimmune disorders was unrevealing. Interestingly, cultures from bronchial washing grew out Nocardia cyriacigeorgica. Subsequently magnetic resonance imaging (MRI) brain was performed to rule out intracranial pathology and HIV screen was negative. He was started on treatment with sulfamethoxazole-trimethoprim. DISCUSSION: Pulmonary nocardiosis is a rare gram-positive bacterial infection typically affecting cell-mediated immunosuppressed patients, however increasing number of cases are presenting in immunocompetent patients. Most patients present with subacute or chronic cough, dyspnea, hemoptysis, chest pain, fever, night sweats, fatigue, and weight loss [2]. There have been few case reports describing pulmonary nocardiosis in the setting of bronchiectasis. Chronic obstructive lung disease and bronchiectasis have been described as risk factors pulmonary nocardiosis, however, the literature is sparse [3]. CONCLUSIONS: In immunocompetent patients presenting with bronchiectasis, maintaining high index of clinical suspicion for pulmonary nocardiosis is essential to ensure accurate diagnosis. Reference #1: Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis. 1976;134(3):286–289. Reference #2: Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc. 2012;87(4):403-407. Reference #3: Woodworth MH, Saullo JL, Lantos PM, Cox GM, Stout JE. Increasing Nocardia incidence associated with bronchiectasis at a tertiary care center. Ann Am Thorac Soc 2017; 14: pp. 347-354. DISCLOSURES: No relevant relationships by Callie Duckworth, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response