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BMJ Case Reports 2012; doi:10.1136/bcr.09.2011.4875
  • Unusual association of diseases/symptoms

A fatal case of pulmonary nocardiosis

  1. Natarajan Rajagopalan4
  1. 1Critical Care Department, Narayana Hrudayalaya Hospital, Bangalore, India
  2. 2Critical Care Services Department, Narayana Hrudayalaya Hospital, Bangalore, India
  3. 3Critical Care Medicine Department, Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
  4. 4Pulmonology and Critical Care Department, Narayana Hrudayalaya Hospital, Bangalore, India
  1. Correspondence to Dr Natarajan Rajagopalan, gopanya{at}hotmail.com

Summary

Pulmonary nocardiosis is a serious, most often considered an opportunistic infection affecting the respiratory tract. Even though it is more common in immunocompromised hosts, it is not infrequently seen in immunocompetent patients as well. The aerosol route is the main portal of entry in to the body. Molecular techniques have revolutionised the identification of Nocardia species. However such tests are limited to referral laboratories. The radiographic appearances of Nocardia infection vary from a small nodule to bilateral infiltrates with cavitation. Traditionally sulphonamides have been considered the treatment of choice. However, resistance to sulphonamides is increasingly recognised. Carbapenems and linezolid have been found to be uniformly active against all the pathogenic species of Nocardia that affect human beings. The authors report a case of pulmonary nocardiosis in an immunocompetent patient, in whom the infection relentlessly progressed to florid sepsis despite prompt institution of right antibiotics. Florid sepsis relating to pulmonary nocardiosis is rare.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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