We discussed a case about an elderly woman with PMH of ESRD s/p renal transplant (within the year) on immunosuppressants & recent history of CMV colitis, who presented with acute fevers, malaise, cough, found to have Pulmonary Nocardia. We learned about:

Main risk factor: immunocompromised state

• Patients on glucocorticoid therapy
• Malignancy
• Organ transplant recipients on immunosuppressant therapy
• AIDS

Sites of infection: Pulmonary, CNS, cutaneous, disseminated

Definitive diagnosis: isolation & identification of the organism
Partially acid-fast w/ modified (Kinyoun stain)

Treatment: dependent on susceptibilities

• 1st line: TMP-SMX
• Alt: linezolid, clarithromycin, amikacin, cephalosporins, carbapenems
• Duration: prolonged course depending on severity (e.g ~3-6 months vs 6-12+ months)