Pulmonary Nocardiosis as an Opportunistic Infection in COVID-19

Secondary bacterial pneumonia infection is frequent in COVID-19 patients. Nocardia are responsible for opportunistic pulmonary infections especially after steroid treatment. We describe a case of pulmonary nocardiosis following critical COVID-19 pneumonia in an 83-year-old male. Two weeks after initiation of dexamethasone 6 mg/L, the patient developed a new episode of acute dyspnea. The sputum cultures identified Nocardia cyriacigeorgica. In spite of intravenous imipenem and cotrimoxazole treatment the patient died. Physicians should be aware of the possibility of nocardiosis in case of deterioration of respiratory status of severe COVID-19 inpatients and perform Nocardia evaluation. This evaluation requires prolonged culture. LEARNING POINTS: Nocardia are responsible for opportunistic pulmonary infections after steroid treatment. We describe a case of pulmonary nocardiosis following critical COVID-19 pneumonia. Physicians should be aware of the possibility of secondary nocardiosis in COVID-19 inpatients.