CTICasesNocardia Pneumonia
Imaging findings
Serial chest CT scans in a patient with AML post-stem cell transplant show a progressive, mass-like consolidative process and interstitial thickening in the right upper lobe apex. The process is surrounded by mild septal lines and interstitial edema. A CT-guided core biopsy of the consolidative lesion yields Nocardia asteroides complex (specifically nocardia asteroides drug pattern VI / Nocardia farcinica).
Key takeaways
Nocardiosis is an opportunistic bacterial infection caused by Nocardia species, which are aerobic, Gram-positive, weakly acid-fast branching bacilli. It typically affects immunocompromised hosts (e.g., transplant recipients, leukemia patients). In the lungs, it commonly presents as subacute consolidations, nodules, or abscesses that can slowly enlarge despite broad-spectrum antifungal or standard antibacterial therapy, requiring targeted trimethoprim-sulfamethoxazole (TMP-SMX) therapy.
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