A Case Report of Nocardia asiatica in a Renal Transplant Recipient

Nocardiosis is a life-threatening disease in solid organ transplant recipients. It is an uncommon but important infection in these patients. Nocardiosis is caused by a Gram-positive, weakly acid fast, branching filamentous aerobic bacteria belonging to the order Actinomycetales. It causes pulmonary and systemic infections in immunocompromised patients. The common species of Nocardia causing infections are Nocardia asteroids, Nocardia brasiliensis, Nocardia farscinica, and Nocardia nova. Here, we report a case of a 32-year-old female postrenal transplant recipient developing pulmonary nocardiosis by a rare species of Nocardia called Nocardia asiatica. A modified Ziehl–Neelsen stain using 1% H2SO4 in the endotracheal (ET) secretion revealed numerous acid fast branching filamentous organisms morphologically resembling Nocardia spp., and the culture grew Nocardia and it was confirmed as N. asiatica by MALDI TOF. Our patient had cytomegalovirus co-infection. The patient was started on trimethoprim-sulfamethoxazole. This case shows the importance of keeping nocardiosis as a differential diagnosis in immunocompromised patients.