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Pulmonary nocardiosis — SCE Respiratory MCQ

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HardRespiratory InfectionsPulmonary nocardiosisSCE Respiratory

A 61-year-old renal transplant recipient presents with pleuritic pain, fever and multiple nodular lung lesions, some cavitating. He is on tacrolimus, mycophenolate and prednisolone. Modified acid-fast staining of sputum shows branching filamentous organisms. What is the most likely diagnosis?

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Correct answer: B — Pulmonary nocardiosis

Immunosuppression with cavitating nodules and weakly acid-fast branching filamentous organisms is typical of Nocardia infection. TB is acid-fast but not branching filamentous, and mucormycosis has broad non-septate hyphae rather than this stain pattern. Septic emboli and eosinophilic pneumonia do not explain the microbiology.

Reference: BTS immunocompromised host guidance; BNF