Pulmonary Nocardiosis in an Immunocompetent Host: A Diagnostic Challenge Requiring Multimodal Evaluation

TL;DR

This paper discusses a rare case of lung infection caused by Nocardia in a patient with a healthy immune system, highlighting the need for advanced diagnostic methods.

Contribution

The novelty lies in presenting a rare case of pulmonary nocardiosis in an immunocompetent individual and emphasizing multimodal diagnostics for timely diagnosis.

Findings

Pulmonary nocardiosis can occur in immunocompetent individuals with chronic lung disease.

Multimodal diagnostic approaches are crucial for diagnosing non-resolving pneumonia cases.

Endobronchial ultrasound-guided transbronchial needle aspiration confirmed the Nocardia infection in this case.

Abstract

Pulmonary nocardiosis is a rare opportunistic infection usually affecting immunocompromised hosts but can present in immunocompetent individuals with chronic lung disease, creating diagnostic challenges. We describe the case of a 72-year-old woman with pulmonary fibrosis who had progressive pneumonia unresponsive to standard therapy. Despite multiple non-diagnostic bronchoscopies, cultures from an endobronchial ultrasound-guided transbronchial needle aspiration of a mediastinal lymph node ultimately confirmed Nocardia species. This case underscores the importance of considering nocardiosis in non-resolving pneumonia among immunocompetent patients and highlights the role of multimodal, invasive diagnostics in establishing a timely diagnosis and guiding targeted therapy.

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