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: email@example.com.
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.