Nocardia prostatitis in a small intestine transplant recipient

A 37-year-old small bowel transplant recipient with a history of urolithiasis was admitted for dysuria after passing a urinary stone. His laboratory evaluation showed increased blood urea nitrogen and creatinine. Urinalysis showed increased white blood cells and positive leukocyte esterase. A computed tomography scan revealed signs of urinary tract obstruction and prostatic enlargement. He failed to respond initially to empiric antibiotic treatment with ciprofloxacin and ampicillin sulbactam while waiting for culture results. The pathogen recovered from both urine and blood culture was subsequently identified as Nocardia asteroides complex. The isolate was sensitive to ceftriaxone and sulfa but resistant to ciprofloxacin. The patient improved on ceftriaxone and trimethoprim-sulfamethoxazole and completed a 6-month course without any relapse. Nocardia prostatitis is an uncommon infection and must be treated with a long course of antibiotics guided by susceptibility testing.