The case of infectious. Pulmonary nocardiosis on renal transplant-female patient. Case report and literature review

Abstract

We present a case of pulmonary nocardiosis in a 62 years old renal-transplanted-female patient undergoing immunosuppressive treatment (cyclosporin, azathrioprine and prednisolone) with nonspecific clinical manifestations. Chest radiographs showed a nodule in the right upper lobe that then developed a cavitation. A CT-guided biopsy performed to the cavitation revealed chronic granulomatous inflammation with giant cells. Then, a video-assisted-thoracotomy was performed, during which the right upper and central lobe where removed. In addition to the granulomatous inflammation, necrosis and accumulation of polymorphonuclear cells. Special stains for acid-fast bacilli and fungi were negatives. Anti.TB treatment was initiated but suspended when the lung-biopsy cultures yielded Nocardia-type filaments. This was confirmed by the Gram-stained tissue sections revealing Gram positive filaments in the center of the abscesses. The patient was successfully treated with Trimethoprim-Sulfamethoxawle. This case illustrates the non-specific manifestations of Pulrnonary Nocardiosis in the clinical, radiological and histopathological aspects. It also emphasizes the need to consider nocardiosis in all immunosupressed patients with respiratory symptoms, an in the differential diagnosis of other infectious diseases more frequently seen in our patients like tuberculosis, mycosis.