Disseminated Nocardiosis in Kidney Transplant Recipients: A Report of 2 Cases

Nocardiosis is a rare, life-threatening opportunistic infection caused by bacteria in the environment that predominantly affects immunocompromised patients. Nocardiosis most commonly involves the lungs but can disseminate to other organs. Disseminated nocardiosis, defined as Nocardia infection involving 2 or more organ systems, requires early detection and treatment because of high morbidity and mortality. We report 2 cases of disseminated nocardiosis with pulmonary and central nervous system involvement in kidney transplant recipients. Nocardiosis should be suspected in immunocompromised patients with fever and lung mass, although atypical presentations involving almost any organ can be seen. Solid organ transplant recipients are at greatest risk for Nocardia infection within the first 1 to 2 years after transplantation. However, the patients presented here developed disseminated nocardiosis several years after transplantation, which has important implications. Nocardiosis is treated with 2 to 6 weeks of empiric induction antibiotics, followed by 6 to 12 months of maintenance antibiotics based on antimicrobial susceptibility testing.