[Pulmonary nocardiosis due to reagudizations in a COPD patient]

Area of Science:

• Infectious Diseases
• Pulmonology
• Microbiology

Background:

• Pulmonary Nocardia infections are uncommon, typically affecting immunocompromised patients.
• Clinical and radiological findings are often non-specific, complicating diagnosis.
• Trimethoprim-sulfamethoxazole (TMP/SMX) is the standard treatment, but resistance can occur.

Observation:

• An 81-year-old male with COPD and chronic glucocorticoid use presented with persistent fever, weight loss, and new pulmonary infiltrates.
• Sputum culture confirmed Nocardia sp. infection.
• The patient experienced relapsing symptoms over three months prior to admission.

Findings:

• Treatment with TMP/SMX led to complete clinical, radiological, and microbiological resolution.
• The patient's underlying conditions (COPD, glucocorticoid therapy) represent risk factors for opportunistic infections.
• Treatment duration varied based on immune status, ranging from 6 weeks to 12 months.

Implications:

• This case underscores the importance of considering Nocardia in the differential diagnosis of pulmonary infections, even in non-immunocompromised patients.
• TMP/SMX remains an effective treatment option for Nocardia pulmonary infections.
• Prompt diagnosis and appropriate antimicrobial therapy are crucial for favorable outcomes.