Pulmonary nocardiosis: Under-diagnosed respiratory opportunistic infection - A case report

Nocardia infection is a rare disorder caused by bacterium, which tends to affect the lung, brain, and skin. Pulmonary nocardiosis is a subacute or chronic pneumonia caused by a species of the family Nocardiaceae. Nocardia particularly affects immunocompromised patients, and only a few reports have described high resolution computed tomography (HRCT) manifestations in a case series of pulmonary infection. Here we describe a case report in which 70 year old patient with history of bronchial asthma on treatment with inhaled corticosteroid presented to emergency with complaints of cough with scanty expectoration and increase in breathlessness. Initially we suspected it to be a case of pulmonary tuberculosis or acute exacerbation of bronchial asthma but later investigations proved it to be a case of opportunistic pulmonary Nocardiosis. He responded well to anti-nocardia therapy and recovered from the symptoms. We conclude that pulmonary Nocardiosis must be suspected and screened in all patients with immunocompromised state and not responding to preliminary diagnosis of chronic obstructive airway disease, asthma or pulmonary tuberculosis.