# Silent Manifestations of Disseminated Nocardia in a Renal Transplant Patient

## TL;DR

A kidney transplant patient showed unusual signs of a widespread Nocardia infection, emphasizing the need for thorough testing in immunocompromised individuals.

## Contribution

Highlights atypical clinical presentation and silent pulmonary involvement in disseminated nocardiosis.

## Key findings

- Patient presented with hip pain and later developed fever and hypoxia, with no respiratory symptoms.
- Imaging revealed a cavitary mass and nodules in the lungs, along with hip myositis and abscess.
- Treatment with imipenem-cilastatin and linezolid was effective for Nocardia species farcinica.

## Abstract

This case report describes a unique presentation of disseminated nocardiosis in a 45-year-old male transplant recipient who initially presented with acute left hip pain. Despite being asymptomatic for respiratory symptoms, the patient developed a fever and subsequently exhibited hypoxia. A diagnostic workup revealed a cavitary mass in the right upper lobe and multiple pulmonary nodules, confirming silent pulmonary nocardiosis. Concurrently, an MRI identified myositis and a possible abscess in the left hip musculature. Treatment involved a regimen including imipenem-cilastatin and linezolid, tailored for Nocardia species farcinica. This case underscores the importance of vigilant evaluation for metastatic infections in immunocompromised patients presenting with atypical symptoms, highlighting the necessity of imaging studies such as CT of the thorax for early detection of silent pulmonary involvement.