Pulmonary involvement due to Nocardia is generally associated with cell-mediated immunosuppressive conditions and risk factors like HIV infection, lymphoproliferative diseases, diabetes and steroid therapy. Pulmonary alveolar proteinosis (PAP) is a well-known risk factor for Nocardia infection and is usually easily detectable on a high-resolution CT scan as ground-glass opacities with geographical distribution, crazy paving pattern and varying amounts of pulmonary consolidation. Pulmonary nocardiosis should be considered in apparently immunocompetent patients who present with PAP and a suspected opportunistic infection. We report a case of pulmonary nocardiosis occurring in a patient with radiologically inapparent PAP. The serendipitous finding of PAP on transbronchial biopsy further increased the likelihood of a Nocardia infection, subsequently confirmed by a surgical biopsy.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine