Disseminated Nocardia infection in a renal transplant patient: the pitfalls of diagnosis and management.

This case report describes the progress of an immunosuppressed renal transplant patient who presented with signs and symptoms of community acquired pneumonia. He did not respond to conventional therapy and underwent further investigation. Definitive diagnosis proved challenging. On the basis of multiple investigation results he was treated variously for bacterial, viral and tuberculous infections. At one point it was thought pulmonary malignancy was likely. After excision of a subcutaneous nodule, microscopy and culture confirmed diagnosis of disseminated Nocardia farcinica. This case demonstrates the difficulty in diagnosing this rare infection in immunocompromised patients, the problems posed by concomitant infection and the potential hazards of multiple drug interactions. On initiation of optimum antimicrobial therapy and with safe levels of immunosuppression our patient made full recovery without any loss in graft function.