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An Unusual Presentation of Pulmonary Nocardiosis

Campos-Santiago, Zulmari MD*; Jimenez-Encarnacion, Esther MD; Vazquez-Sanabria, Irma L. MD; Rodríguez-Cintrón, William MD, FACP, FCCM

Infectious Diseases in Clinical Practice: May 2012 - Volume 20 - Issue 3 - p 213–215
doi: 10.1097/IPC.0b013e318234c4c1
Case Reports

Nocardia is an ubiquitous microorganism found in soil, organic matter, and water. It is particularly common in immunocompromised patients. A 51-year-old man, nonsmoker with medical history of hypertension and chronic alcoholism, presented with a 2-week history of a right upper quadrant pain, right-side chest pain, general malaise, fatigue, anorexia, 20-lb weight loss, night sweats, unquantified fever, and visual/auditory hallucinations. An abdominal and chest computed tomography reported a right pleura–based mass that eroded into the chest wall. The patient was admitted with diagnosis of suspected primary lung malignancy with a postobstructive pneumonic infection. Intravenous antibiotic was started with vancomycin and piperacillin/tazobactam. Computed tomography–guided needle biopsy was done and pathology reported a gram-positive filamentous branching bacteria, weakly acid-fast positive, consistent with a Nocardia infection. Trimethoprim/sulfamethoxazole therapy, together with pleural effusion management, ensured further resolution of this invasive pleuropulmonary infection.

From the *Pulmonary and Critical Care Fellowship Training Program, †Internal Medicine Training Program, and ‡Program Director Pulmonary/Critical Care Medicine Fellowship Training Program, VA Caribbean Healthcare System, San Juan, Puerto Rico.

Correspondence to: William Rodríguez-Cintrón, MD, FACP, FCCM, Pulmonary/Critical Care Medicine Section, San Juan Veterans Affair Medical Center, 10 Casia St, San Juan PR 00921-3201. E-mail:

The authors have no funding or conflicts of interest to disclose.

This work was supported by Sociedad De Investigación Cientifica, Inc (SODEINC), Veterans Plaza Station, San Juan, PR 00933-0060.

This paper was presented in part at the American Thoracic Society Annual Meeting, New Orleans, LA, May 2010.

© 2012 Lippincott Williams & Wilkins, Inc.