Title: An Uncommon Granulomatous Infection in a Post Renal Transplant Patient
Authors: Dr Vasireddy Teja, Dr Y.V.S. Prabhakar MD
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.21
Abstract
Introduction: Nocardiosis is acute, subaute or chronic suppurative infection. Two characteristics of nocardiosis is its ability to disseminate to virtually any organ particularly to central nervous system.
Case Report: A 27 yrs unmarried female with 7 months history of post renal transplant (allograft), chronic hepatitis B viral infection on immunosupressants (tacrolimus, corticosteroids, mycophenolate mofetil) came to hospital with chief complaints of cough, fever since 2 months. Required investigations like complete blood picture, chest radiograph, computerised tomogram of chest were sent and diagnosed as non-resolving pneumonia and treated with antituberculos therapy. In between the treatment patient developed seizures hence magnetic resonance imaging of brain with magnetic resonance spectroscopy was advised which revealed granulomatous lesion. In view of non-resolving pneumonia computerised tomogram guided lung biopsy was done from the pneumonic patch which revealed nocardiosis. Hence, treatment with feropenam, co-trimoxazole, linezolid was initiated. After 2 months there is complete resolution of lung lesions and partial resolution of brain lesions.
Conclusion: Disseminated nocardiosis occurs in people with deficient cell-mediated immunity. The hallmark of cerebral nervous system nocardiosis is formation of a parenchymal abscess that can occur in any region of brain. For cerebral nervous system involvement one year of treatment is required.
Keywords: Nocardia, post renal transplant.
