Disseminated drug-resistant nocardiosis in a patient with advanced HIV

Disseminated nocardiosis is an opportunistic infection seen primarily in patients with impaired phagocyte function, and less frequently in people with advanced HIV. Nocardia pseudobrasiliensis is a species that exhibits high rates of antimicrobial resistance, including to carbapenems, co-trimoxazole, and aminoglycosides. In this article, we present a case of an individual with advanced HIV infection and disseminated N. pseudobrasiliensis. Prior to completion of antimicrobial susceptibility testing, he was treated empirically with imipenem, co-trimoxazole, and amikacin, but demonstrated radiologic progression. Directed therapy with linezolid and azithromycin was ultimately initiated, resulting in marked symptomatic and radiologic improvement after one year of treatment alongside suppressive antiretroviral therapy.