A Curious Cause of Cavitations: Nocardia Pneumonia

  • Jose M. Pacheco
    Requests for reprints should be addressed to: Jose M. Pacheco, Division of Hematology and Oncology, Department of Internal Medicine, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, VA 111H, 2002 Holcombe Blvd, Houston, TX 77030.
    Departments of Hospital Medicine and Internal Medicine, Barnes-Jewish Hospital, Saint Louis, MO

    Departments of Hospital Medicine and Internal Medicine, Veterans Affairs St. Louis Health Care System: John Cochran Division, Saint Louis, MO

    Departments of Hospital Medicine and Internal Medicine, Washington University School of Medicine, Saint Louis, MO
    Search for articles by this author
  • Deborah Goldberg
    Departments of Internal Medicine and Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO
    Search for articles by this author
      Computed tomography (CT) highlighted an alarming discovery, the source of which proved difficult to pinpoint. A 58-year-old man with AIDS presented to the hospital with progressive shortness of breath and cough. Six weeks earlier, he was found to have a left upper lobe cavitary lesion. At that time, he was treated with clindamycin for a lung abscess, and highly active antiretroviral therapy (HAART) was restarted; the patient had a long history of noncompliance and had not been using HAART for more than 6 months. Nonetheless, in the ensuing weeks, he experienced fevers, a 20-lb weight loss, and hemoptysis. His past medical history included large cell lymphoma 14 years earlier, cytomegalovirus retinitis, and a recent episode of esophageal candidiasis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aviram G.
        • Fishman J.E.
        • Sagar M.
        Cavitary lung disease in AIDS: etiologies and correlation with immune status.
        AIDS Patient Care STDS. 2001; 15: 353-361
        • Lin C.Y.
        • Sun H.Y.
        • Chen M.Y.
        • et al.
        Aetiology of Cavitary lung lesions in patients with HIV infection.
        HIV Med. 2009; 10: 191-198
        • Rodríguez Arrondo F.
        • von Wichmann M.A.
        • Arrizabalaga J.
        • et al.
        Pulmonary cavitation lesions in patients infected with the human immunodeficiency virus: an analysis of a series of 78 cases.
        Med Clin (Barc). 1998; 111: 725-730
        • Gallant J.E.
        • Ko A.H.
        Cavitary pulmonary lesions in patients infected with human immunodeficiency virus.
        Clin Infect Dis. 1996; 22: 671-682
        • Brown-Elliot B.A.
        • Brown J.M.
        • Conville P.S.
        • Wallace Jr., R.J.
        Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy.
        Clin Microbiol Rev. 2006; 19: 259-282
        • Diego C.
        • Ambrosioni J.C.
        • Abel G.
        • et al.
        Disseminated nocardiosis caused by Nocardia abscessus in an HIV-infected patient: first reported case.
        AIDS. 2005; 19: 1330-1331
        • Wilson J.W.
        Nocardiosis: updates and clinical overview.
        Mayo Clin Proc. 2012; 87: 403-407
        • Kanne J.P.
        • Yandow D.R.
        • Mohammed T.L.
        • Meyer C.A.
        CT findings of pulmonary nocardiosis.
        AJR Am J Roentgenol. 2011; 197: W266-272
        • Welsh O.
        • Vera-Cabrera L.
        • Salinas-Carmona M.C.
        Current treatment for Nocardia infections.
        Expert Opin Pharmacother. 2013; 14: 2387-2398