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A Curious Cause of Cavitations: Nocardia Pneumonia

  • Jose M. Pacheco
    Correspondence
    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.
    Affiliations
    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
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  • Deborah Goldberg
    Affiliations
    Departments of Internal Medicine and Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO
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      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.
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