CTICasesNocardiosis in a Heart Transplant Patient
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Imaging findings
An initial radiograph was available. A CT performed for pulmonary embolism also showed a peripheral area of consolidation and ground glass on the right, as well as a cavitary lesion in the lower lobe with a relatively thin wall and some debris. A later CT revealed new nodularity with cavitation and satellite nodules, appearing granulomatous and airway-centered. The cavity wall became thinner over time.
Key takeaways
In immune-suppressed patients, Nocardia tends to present as larger lesions and often manages more like a fungal infection, mimicking cryptococcus or coccidioidomycosis. The patient was treated for community-acquired pneumonia but did not respond, with nocardiosis later confirmed. Nocardia responds to sulfa drugs, and its incidence has decreased due to widespread Pneumocystis prophylaxis. Cases are typically seen in transplant patients or those with lupus.
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