Nocardia infection is an increasing concern in solid organ transplant recipients due to prolonged immunosuppression. A relatively uncommon and underrecognized pathogen, Nocardia infections pose several challenges, from diagnosis to clinical management. A 45-year-old woman with cystic fibrosis underwent bilateral lung transplantation in 2016. Eight years post-transplant, she developed progressive respiratory symptoms. Imaging revealed cavitary nodular lesions, and Nocardia cyriacigeorgica was isolated from bronchoalveolar lavage and sputum cultures. Treatment with meropenem and trimethoprim-sulfamethoxazole led to clinical and radiological improvement. This case highlights diagnostic challenges of Nocardia infections, the importance of microbiological interpretation, and the potential for late-onset disease in transplant recipients even with prophylaxis. Awareness of Nocardia as an opportunistic pathogen is essential for timely diagnosis and management. Our findings reinforce the need for continuous vigilance in solid organ transplant recipients, especially in cases of persistent pulmonary infections and intense immunosuppressive therapy.
Caian L Vinhaes (Sun,) studied this question.