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VOLUME 10 , ISSUE 1--4 ( January-December, 2024 ) > List of Articles


Case Report on Unveiling Nocardia: Incidental Discovery in Transplant and Liver Disease Patients

Prateet Kaur, Ashina Singla, Snigdha Purohit, Singh K Kumar

Keywords : Alcoholic liver disease, Case report, Immunocompromised, Modified Ziehl–Neelsen stain, Nocardia, Renal transplant

DOI: 10.5005/jp-journals-10045-00265

License: CC BY-NC 4.0

Published Online: 20-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: Nocardia infections pose a significant challenge in immunocompromised patients, including solid organ transplant recipients and those with liver diseases such as alcoholic liver disease. These infections can often be misdiagnosed or overlooked due to their resemblance to tuberculosis and other pulmonary pathogens. Understanding the clinical presentation, risk factors, diagnostic challenges, and treatment outcomes of Nocardia infections in these populations is crucial for improving patient care and outcomes. The aim of this case series is to highlight the incidental discovery of Nocardia infections in transplant patients and individuals with liver diseases, shedding light on their clinical presentations, diagnostic approaches, management strategies, and treatment outcomes. By elucidating the challenges associated with diagnosing and managing Nocardia infections in these high-risk populations, we aim to underscore the importance of early recognition and appropriate treatment to reduce morbidity and mortality. Furthermore, we aim to emphasize the need for improved diagnostic tools and therapeutic interventions tailored to the unique characteristics of these patients. Through this case report, we seek to contribute to the existing literature on Nocardia infections in immunocompromised hosts and provide insights for clinicians managing similar cases in their practice. Case description: We report two cases of incidental discovery of Nocardia infections—one in a 38-year-old male with acute-on-chronic liver failure and acute kidney injury, and another in a 40-year-old male postrenal transplant. Diagnosis was confirmed through modified acid-fast staining of respiratory samples, and treatment with empirical antibiotics followed by targeted therapy with cotrimoxazole resulted in contrasting outcomes. Despite aggressive management, the patient with liver disease succumbed to the infection, while the transplant recipient showed symptomatic improvement and was discharged. Conclusion: Growing transplant rates and new immunosuppressive therapies are increasing Nocardia infections, which are often diagnosed late. Improved diagnostic tools, especially molecular techniques like MALDI-TOF MS and gene sequencing, are needed for early identification to reduce mortality in immunocompromised patients. Clinical significance: The clinical significance of this manuscript lies in its illumination of the challenges associated with diagnosing and managing Nocardia infections in immunocompromised patients, specifically solid organ transplant recipients and individuals with liver diseases.

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