Disseminated nocardiosis and focal nontuberculous mycobacterial infection coexisting in a renal transplant recipient - A case report

Abstract

Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections, as they are on immunosuppressive drugs. The risk increases if the cumulative immunosuppression is high, especially when the patient is treated for acute rejection episodes. Multiple opportunistic infections in the same patient are reported in SOT recipients. We report a 43-year-old man, renal allograft recipient, 15 years posttransplant, on dual immunosuppression who presented with fever, generalized skin rashes, and altered sensorium. He was recently treated with pulse methylprednisolone injections for acute graft rejection episode. He had multiple pustules all over the body, predominantly over the face, eyelids, chest, and lower limbs. Pus from the facial lesion grew Nocardia, and tissue culture of skin ulcer from the leg grew nontuberculous mycobacteria. Combined infection with these organisms posed diagnostic challenge as both can present with cutaneous manifestation, both organisms are acid-fast bacilli, and both organisms were detected and grown from the sample taken from one of the large skin ulcers. It was important to identify both the organisms from the skin ulcer as the treatment options are different.

Keywords

• kidney transplant
• nocardia
• nontuberculous mycobacteria
• skin ulcer