SHM Converge Scientific Abstract ePoster Gallery-Two Rare and Inopportune Infections: A Case Report of Coinfection With Nocardosis and Apergillosis in a Renal Transplant Patient

Two Rare and Inopportune Infections: A Case Report of Coinfection With Nocardosis and Apergillosis in a Renal Transplant Patient

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This case report describes a 56-year-old male renal transplant recipient with diabetes, CKD, and prior farm work who developed a rare dual opportunistic infection: pulmonary nocardiosis and disseminated Aspergillus niger. He presented with a 3-week history of cough, pleuritic chest pain, night sweats, weight loss, and fatigue after traveling in Idaho. Initial imaging showed bilateral lung nodules and a mass-like opacity, raising concern for malignancy or tuberculosis. Because he was immunocompromised and had environmental soil exposure, the team pursued infectious workup including fungal serologies, CT imaging, bronchoscopy with BAL, and biopsy of a new hand nodule.<br /><br />BAL cultures ultimately grew Aspergillus niger and Nocardia species, and the hand lesion was also positive for Aspergillus, confirming disseminated disease. Later sputum cultures identified multiple Nocardia species, including Nocardia abscessus complex, N. exalbida, and N. gamkensis. He was treated with posaconazole for Aspergillus and TMP/SMX plus imipenem/cilastatin initially for Nocardia, later narrowed to TMP/SMX and doxycycline. Imaging and clinical follow-up showed improvement, and chest CT 15 months later demonstrated resolution of opacities with residual scarring.<br /><br />The report emphasizes that rare soil-associated pathogens such as Nocardia and Aspergillus should be considered early in immunocompromised patients, especially transplant recipients with rural or occupational exposures. Early diagnosis may prevent progression to disseminated infection, reduce hospital stay, and improve outcomes.

Asset Subtitle

Rogelio Pinon-Gutierrez

Meta Tag

Author List Cesar Y. Carreon, Rogelio Pinon-Gutierrez

Category Clinical Vignettes

Concept Opportunistic Infection

Concept Nocardia

Concept Aspergillus

Concept Immunocompromised State

Concept Solid Organ Transplant

Distinguished Non-Finalist

Presenter Organization UC Davis

Presenting Author Rogelio Pinon-Gutierrez

Track Adult

Keywords

renal transplant

opportunistic infection

pulmonary nocardiosis

Aspergillus niger

disseminated aspergillosis

immunocompromised host

soil exposure

bronchoalveolar lavage

Nocardia species

transplant recipient

Opportunistic Infection

Nocardia

Aspergillus

Immunocompromised State

Solid Organ Transplant