Medical image of the week: nocardiosis

Abstract

No abstract available. Article truncated at 150 words. A 67 year-old man with advanced adenocarcinoma of the lung on chemotherapy and severe steroid dependent chronic obstructive pulmonary disease (COPD) was admitted for treatment of acute on chronic respiratory failure. He was admitted to the intensive care unit and required non-invasive positive pressure ventilation. He had a chest computed tomography scan (Figure 1A), with a left upper lobe mass, which was significantly larger than noted on a previous PET/CT scan (Figure 1B) from one month ago. He was placed on empiric broad-spectrum antibiotics and clinically improved. He underwent a transthoracic lung biopsy (Figure 2), which revealed the presence of organisms consistent with Nocardia on silver stain. A brain MRI (Figure 3) showed the presence of a 4 mm enhancing lesion likely consistent with Nocardia.Nocardiosis is a gram-positive bacterial infection caused by aerobic actinomycetes and is an important opportunistic pulmonary infection. It should be considered in the differential diagnosis ...

Keywords

• nocardiosis
• nocardia
• pneumonia
• brain abcess
• treatment
• trimethoprim-sulfamethoxazole
• CT scan
• brain MRI
• MRI
• silver stain