Nocardial infection in patients with neoplastic disease

During the 13 years from 1974 through 1986, nocardial infection was diagnosed in 14 cancer patients treated at the M. D. Anderson Cancer Center (Houston). Underlying diseases included solid tumors in eight patients and hematologic malignancies in five; there was no underlying disease in one patient. The types of infection were bronchopneumonia, cavitary pneumonia, empyema, brain abscess, meningitis, and cutaneous abscesses. Eleven patients received antineoplastic therapy prior to the onset of their infection. Among the 11 patients in whom infection was diagnosed antemortem, nine who were treated with sulfadiazine or trimethoprim-sulfamethoxazole had a favorable response to therapy. Nocardiosis occurs infrequently in cancer patients but causes serious infection. Physicians must be alert to this possibility so that appropriate therapy can be given promptly and the chances of a favorable outcome thereby increased.