Nocardia beijingensis: An elusive diagnosis, but a favourable outcome

Abstract

A 71 year old male, diabetic; had cough, low-grade fever with significant weight loss. A lesion along the mediastinal surface of the lung was seen. CT guided biopsy showed acute suppurative inflammation. Tuberculosis, Melioidosis, Mould infection, Nocardia & Actinomycosis were in the differential diagnosis and was treated with Doxycycline. However, 2 months later, abdominal discomfort with fever developed and a new necrotic lesion had developed in the right adrenal gland. Biopsy revealed Nocardia beijingensis, identified by MALDI TOF MS. Treatment with TMP SMX & Linezolid led to cure.