Disseminated Nocardiosis in renal transplant recipient under therapy for pulmonary tuberculosis: a case report.
BACKGROUND
Nocardiosis is an opportunistic infection in a patient with underlying immune suppression and organ transplant. Clinical syndromes are varied and ranges from pulmonary, disseminated, cutaneous along with central nervous system involvement.


METHODS
Herein, we report a rare case of disseminated pulmonary nocardiosis with cerebral manifestation in a 66 year-old-Nepali farmer; with a history of renal transplantation and undergoing therapy for pulmonary tuberculosis. Radiographic imaging revealed multiple opacities of varying sizes in bilateral lung field mediastinal, retroperitoneal lymphadenopathy, and ill-defined lesion with surrounding edema seen in left occipitoparietal region of brain. Bacteriological assessments of bronchoalveolar lavage and purulent fluid extracted intra-operatively from the lesion confirmed the case as Nocardiosis.


CONCLUSIONS
Disseminated Pulmonary nocardiosis with central nervous system involvement carries a poor prognosis. However, early diagnosis of the case, the administration of appropriate antibiotic, stereotactic aspiration alone or craniotomy has a successful outcomes even in a post renal transplant patient treated with anti tuberculosis treatment.
Tribhuvan University Teaching Hospital, Kathmandu, Nepal. khadka.priyatam@gmail.com.|Trichandra Multiple Campus, Tribhuvan University, Ghantaghar, Kathmandu, Nepal. khadka.priyatam@gmail.com.
Priyatam
P
Khadka
Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Ramesh Bahadur
RB
Basnet
Central Department Tribhuvan University, Ghantaghar, Kathmandu, Nepal.|Deerwalk Services Pvt. Ltd, Kathmandu, Nepal.
Pratap
P
Khadka
Department of Nephrology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Dibya Singh
DS
Shah
Institute of Medicine, Kathmandu, Nepal.
Bharat Mani
BM
Pokhrel
Institute of Medicine, Kathmandu, Nepal.
Basista Parsad
BP
Rijal
Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Jeevan Bahadur
JB
Sherchand
D000368:Aged; D001922:Brain Abscess / Q000175:diagnosis; D015897:Comorbidity; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009390:Nepal; D009615:Nocardia; D009617:Nocardia Infections / Q000150:complications* / Q000628:therapy; D009894:Opportunistic Infections / Q000150:complications / Q000628:therapy; D011379:Prognosis; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000628:therapy
D007166:Immunosuppressive Agents
Cerebral abscesses; Disseminated Nocardiosis; Immune suppression; Pulmonary tuberculosis; Renal transplant