Infectious Disease · Nephrology · 1 h ago
Resistant Nocardiosis Breaks Through Prophylaxis in Renal Transplant Recipient
A case report describes disseminated, trimethoprim/sulfamethoxazole-resistant nocardiosis in a 39-year-old renal transplant recipient in India who was receiving prophylaxis. After susceptibility-guided treatment, pulmonary and cerebral lesions resolved by six months; species-level identification was not achieved.
- Nocardiosis developed despite trimethoprim/sulfamethoxazole prophylaxis.
- Pulmonary and cerebral disease resolved after six months of treatment.
- Susceptibility testing identified apparent trimethoprim/sulfamethoxazole resistance.
- Species-level identification was unsuccessful.
The report describes a 39-year-old woman receiving tacrolimus, mycophenolate, prednisolone, and trimethoprim/sulfamethoxazole prophylaxis after renal transplantation. After 14 months, she developed pulmonary disease and was diagnosed with invasive aspergillosis. Subsequent neurologic symptoms and brain imaging showing multiple lesions prompted further investigation; lung tissue findings and culture supported disseminated nocardiosis involving the lungs and brain.
The isolate appeared resistant to trimethoprim/sulfamethoxazole and ciprofloxacin, and susceptible to linezolid, minocycline, imipenem, and amikacin. Treatment was adjusted after cytopenias and seizure-risk concerns; pulmonary and intracranial lesions had resolved radiologically at six months, with graft function preserved. The patient remained well at one-year follow-up while receiving secondary minocycline prophylaxis.
This single case illustrates breakthrough infection despite prophylaxis and the potential value of susceptibility testing in guiding therapy. Species-level identification was not possible, and susceptibility testing for Nocardia can be technically challenging. The report also cites substantial variability in published resistance estimates, so this case cannot establish prevalence or generalize treatment outcomes. The article is an early-release report and may be revised before final publication.
In practice
In renal transplant recipients with suspected pulmonary nocardiosis, this report supports considering CNS involvement and using antimicrobial susceptibility results to inform treatment, since infection occurred despite trimethoprim/sulfamethoxazole prophylaxis and the isolate appeared resistant. The patient’s pulmonary and cerebral lesions resolved after a prolonged, adjusted regimen, but this is one case, species identification was unsuccessful, and Nocardia susceptibility testing can be technically difficult. The report does not establish resistance prevalence or a preferred regimen, so it does not justify changing prophylaxis or treatment policy on its own.
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Emerging Infectious Diseases: Disseminated Trimethoprim/Sulfamethoxazole–Resistant Nocardiosis in Renal Transplant Recipient, India ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.