title: Pulmonary nocardiosis due to Nocardia farcinica in a renal transplant recipient.
abstract: Nocardia farcinica is an infrequent cause of nocardiosis among the renal transplant recipients and it has not been reported so far from India. We report a case of pulmonary nocardiosis due to N. farcinica in a 32-year-old woman with hypothyroidism and post-renal transplant status, currently on immunosuppressive therapy (prednisolone, azathioprine and tacrolimus). The N. farcinica isolate was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), linezolid, imipenem, gentamicin but resistant to ceftriaxone, ciprofloxacin, tobramycin, erythromycin, amoxycillin-clavulanic acid and tetracycline. Treatment with TMP-SMZ and linezolid resulted in marked clinico-radiological improvement but after two weeks both of the drugs had to be stopped due to severe pancytopenia as adverse effect of their use. Currently, the patient is on imipenem and remains stable after four weeks of treatment. In N. farcinica infections, multi antibiotic resistance and toxicity of some specific drugs enhances the risk of therapeutic failure in renal transplant recipients.
authors.affiliation: Department of Pulmonary Medicine, Kasturba Medical College, Manipal, India.
authors.forename: K
authors.initials: K
authors.lastname: Gowrinath
authors.forename: Waqas Wahid
authors.initials: WW
authors.lastname: Baig
authors.forename: Attur Ravindra
authors.initials: AR
authors.lastname: Prabhu
authors.forename: Kiran
authors.initials: K
authors.lastname: Chawla
authors.forename: Indira
authors.initials: I
authors.lastname: Bairy
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D009615:Nocardia / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis / Q000209:etiology* / Q000635:transmission; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology*