Disseminated Trimethoprim/Sulfamethoxazole-Resistant Nocardiosis in Renal Transplant Recipient, India.
Sandeep Rao Kordcal, Md Tariq Maula, Vivek Malleshappa Suguna et al.
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Case in brief
A renal transplant recipient in India taking trimethoprim/sulfamethoxazole prophylaxis presented with fever, hemoptysis, and neurologic deficits. Evaluation identified pulmonary aspergillosis and disseminated nocardiosis due to trimethoprim/sulfamethoxazole-resistant Nocardia. Antimicrobial therapy was followed by complete clinical and radiological resolution after 6 months.
What made this case unusual
Disseminated nocardiosis occurred despite trimethoprim/sulfamethoxazole prophylaxis, with the causative Nocardia resistant to that drug combination.
Diagnostic / clinical pearl
In a transplant recipient taking trimethoprim/sulfamethoxazole prophylaxis, disseminated nocardiosis remains a diagnostic consideration when fever and neurologic deficits occur; prophylaxis does not exclude infection with a resistant pathogen.