Nocardia pneumonia

Nocardia pneumonia is a relatively rare lung infection in Taiwan. It is usually related to contact with soil or contaminated water. A 39-year-old previously healthy man had a work-related fall resulting in multiple wounds and fractures as well as aspiration of river water and soil. His hospital course was complicated by facial necrotizing fasciitis due to aeromonas species and acinetobacter pneumonia. Despite meropenem treatment for the latter, his pneumonia failed to resolve. Gram stain of fluid from bronchoalveolar lavage demonstrated nocardia, and he improved after trimethoprim-sulfamethoxazole added to the meropenem he was already receiving. When a patient with pneumonia has a history of soil or river water aspiration and the lung infection responds poorly to antimicrobial therapy for community-acquired pneumonia, pulmonary nocardiosis should be considered and a careful search performed for evidence of the organism is necessary. ( J Intern Med Taiwan 2008; 19: 270-274 )