Nocardia nova causing empyema necessitatis afterlung re-transplantation: a case report

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Transplantation Immunology

Background:

• Lung re-transplantation is a complex procedure often associated with significant risks, including opportunistic infections.
• Alpha-1-antitrypsin deficiency-related emphysema is a known indication for lung transplantation.
• Nocardia species are aerobic actinomycetes capable of causing severe, disseminated infections, particularly in immunocompromised individuals.

Observation:

• A patient who underwent lung re-transplantation for emphysema experienced a thoracic infection.
• The infection, identified as Nocardia nova via 16S ribosomal deoxyribonucleic acid (rDNA) sequencing, spread from the lung to the pleural space, thoracic wall, and mediastinum.
• Clinical manifestations included pericarditis and empyema necessitatis.

Findings:

• Nocardia nova was confirmed as the causative agent through molecular identification (16S rDNA sequencing and phylogenetic analysis).
• The infection presented as a complex thoracic involvement, extending beyond the transplanted lung.
• This represents the first reported case of empyema necessitatis caused by Nocardia nova in a lung transplant recipient.

Implications:

• This case underscores the importance of considering Nocardia infections in lung transplant recipients presenting with unusual thoracic pathology.
• Prompt and accurate identification of Nocardia species is crucial for effective treatment and management of post-transplant infections.
• Further research may be warranted to understand the specific risk factors and optimal treatment strategies for Nocardia infections in this vulnerable patient population.