Case report
Year : 2025 Month : October-December Volume : 14 Issue : 4 Page : MC01 - MC04

Thinking beyond Tuberculosis: Pulmonary Nocardiosis by Nocardia farcinica in a Patient with Autoimmune Hepatitis
Arundhuti Paul, Vikas Khillan, Ankita Saran, Pratibha Kale, Venkat Goutham Nag
1. Senior Resident, Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India. 2. Professor and Head, Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India. 3. Senior Resident, Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India. 4. Additional Professor, Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India. 5. Senior Resident, Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India.
 
Correspondence Address :
Dr. Arundhuti Paul,
1st Floor, E-990 Chittaranjan Park, New Delhi, India.
E-mail: write2mearundhati@gmail.com
 
ABSTRACT
Nocardiosis is a rare but serious infection caused by Nocardia species (class Actinobacteria, order Corynebacteriales). Nocardia is commonly found in soil, dust and plant material, and the infection primarily affects immunocompromised individuals, most often presenting as Pulmonary Nocardiosis (PN) via inhalation. It requires a prolonged course of antimicrobials and is a significant cause of mortality in such patients. PN is often misdiagnosed as Tuberculosis (TB) due to overlapping features, delaying diagnosis and treatment. This case describes a 44-year-old male, a known case of autoimmune hepatitis on corticosteroid therapy, who presented with clinical and radiological features suggestive of pulmonary TB. Modified Kinyoun staining of pleural fluid showed acid-fast, branched, filamentous bacilli and culture grew yellow, chalky colonies identified as Nocardia farcinica. The organism was also isolated on automated and conventional mycobacterial culture media. The patient was successfully treated with cotrimoxazole (double strength). This emphasises the need to include Modified Ziehl-Neelsen (ZN) stain as a rapid screening test to rule out PN and avoid treatment with Antitubercular Therapy (ATT).
Keywords : Corticosteroids, Immunocompromised, Infection, Modified Ziehl-Neelsen stain, Pleural effusion