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Nocardiosis — SCE Respiratory MCQ

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HardRespiratory infectionsNocardiosisSCE Respiratory

A 36-year-old renal transplant recipient develops fever, cough and pleuritic pain. CT shows multiple nodules, two with cavitation, and a small brain abscess is seen on MRI after he reports headache. He takes tacrolimus and prednisolone; neutrophil count is normal. Modified acid-fast staining of sputum is positive for branching filamentous organisms. What is the most likely diagnosis?

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Correct answer: B — Nocardia pulmonary infection with dissemination

Nocardia causes cavitating pulmonary nodules and can disseminate to the brain in transplant recipients; weakly acid-fast branching filaments are a key clue. TB is plausible but the staining morphology and brain abscess pattern favour nocardiosis. Immunosuppressed patients with cavitating nodules need microbiology that includes bacterial, mycobacterial and fungal causes.

Reference: BTS immunocompromised host pneumonia resources; transplant infection guidance