CTICasesNocardia Farcinica in a Patient on High-Dose Steroids
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Imaging findings
Initial chest radiograph and CT showed only atelectasis in lung bases despite eosinophilia. After a course of high-dose steroids, the patient developed a cough and new vague opacities. A follow-up CT showed multiple cavitary lung nodules, predominantly in the upper lungs but also scattered in lower lungs. Bronchoalveolar lavage grew branching gram-positive rods, identified as Nocardia farcinica.
Key takeaways
Nocardia infections (like Nocardia farcinica) should be highly suspected in immunocompromised patients, including those on high-dose corticosteroids or solid organ transplant recipients. Imaging findings often include cavitary lung nodules. The incidence of Nocardia has decreased due to pneumocystis prophylaxis, but it can still emerge, especially when patients are off prophylaxis. Nocardia is a bacteria that behaves like a fungus on imaging and is always pathogenic.
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