Disseminated nocardia pseudobrasiliensis in a renal transplant recipient

Nocardia are aerobic actinomycetes that cause localized and disseminated disease in both immunocompetent and immunosuppressed individuals. Nocardia pseudobrasiliensis is a recently recognized nocardial species associated with invasive manifestations of disease. We herein describe a case of disseminated N pseudobrasiliensis involving the central nervous system, lungs, thyroid, skin, and soft tissue of a renal transplant recipient. Diagnosis proved challenging owing to inconsistent staining of the cell wall with routine stains and poor growth in culture media. The patient improved with appropriate antibiotic therapy, but she was left with paraplegia. Recognition of N pseudobrasiliensis as an emerging opportunistic pathogen is imperative in the care of at risk transplant recipients.