Pulmonary Nocardiosis in an HIV-Infected Patient - Need for early diagnosis: A Case Report

Abstract

The species Nocardia is majorly found in soil, invades primarily through respiratory route, and establishes the infection in the persons with immunocompromised status. A long-term immunosuppressive therapy, HIV and carcinomas are the most common reasons for a person to become immunocompromised. There is often a persisting confusion in the confirmatory diagnosis of pulmonary nocardiosis as the clinical manifestations are similar to that of pulmonary tuberculosis. Here we are presenting a case on Pulmonary Nocardiosis in a 33-year-old male HIV patient having complaints of fever, cough with expectoration and anorexia since 5 days. Chest X ray depicted the presence of fibrocavitatory lesions in mid and lower zones with a bilateral pleural effusion, predominant on left side. Sputum culture showed absence of acid-fast bacilli (AFB) and revealed presence of gram-positive organisms suggesting few Nocardia like species. Patient was given with line of treatment for pulmonary nocardiosis and was symptomatically better within 5 days of treatment. Pulmonary nocardiosis has to be considered under differential diagnosis while suspecting pulmonary TB with fibrocavitatory lesions. In case of suspected radiological finding along with a negative AFB culture report, testing for Nocardia species should be considered in the HIV positive patients and should be started on empirical therapy to prevent further worsening of condition.