Nocardiosis in a Patient with Nephrotic Syndrome Treated with Glucocorticoids and Tacrolimus

Nephrotic syndrome (NS) predisposes patients to immunocompromised hosts owing to the loss of immunoglobulins, immunosuppressant use, and edema complications. In addition, aging impairs the immune system; thus, elderly individuals with NS are vulnerable to infection. Nocardiosis is not a common disease; however, once infected, it can disseminate hematogenously, causing serious health problems. An 88-year-old woman with amyloid light chain amyloidosis-induced NS was treated with prednisolone and tacrolimus and developed nocardiosis and invasive aspergillosis. Protecting the skin and wounds from direct exposure to nocardia is important. Physicians should consider the safe dose and treatment period of immunosuppressants in elderly patients with NS.