55 yo ♂️s/p RenalTx 10+yrs ago tacro/aza immunosuppressive, gardens & recent travel to home (Philippines), presents chronic progressive cough, constitutional features & single skin abscess, with non-cavitary RUL consolidation + diffuse ggo refractory to Levaquin...
Do you start antibiotics? If Yes: tell me which ones in comment
What’s your leading Dx:
Given my DDx, wanted AFB + Nocardia sputum culture
AFB sputum positive.
“Branching weakly AF positive”
Ultimately dx with Disseminated Nocardia. CMV was red herring (probable cause of transaminases)
1) risk factors Nocardia: immunosuppressed, EtOH, recent transplant
2) Nocardia is all over: mostly in dirt (hence gardener)
3) Nocardia loves lungs and 🧠 ==> must get MRI brain if immunosuppressive or Sx of neuro defect
4) Nocardia & actinomycetes are on DDx for AFB