• Yan Xiao, Hongwei Wang, Tingting Tian, Juanjuan Zheng, Mengyang Liu, Qing Wang, and Jing Li.
• Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, China.
• Medicine (Baltimore). 2024 Dec 6; 103 (49): e40054e40054.

RationaleNocardia is a conditionally pathogenic bacterium found in the natural environment and is an aerobic bacterium, which causes severe pneumonia relatively rarely. The diagnosis of primary Nocardia infection is always made late due to the nonspecific clinical presentation of patients with Nocardia infection and the time required for Nocardia culture. Due to its rarity and nonspecific clinical presentation, patient survival is often compromised due to misdiagnosis.Patient ConcernsA 53-year-old woman with autoimmune cirrhosis was treated with glucocorticoids. Three and a half months later the patient developed fever, nausea, cough and sputum, treated with empirical antibiotics, and the patient occurred type I respiratory failure.DiagnosesNocardia was identified by sputum culture micromorphology and Meriere matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF).InterventionsThe patient was treated with trimethoprim-sulfamethoxazole (TMZ), and the patient's oxygen saturation recovered significantly.OutcomesThe patient's overall recovery was slow due to decreased albumin (ALB) and increased procalcitonin (PCT) caused by the patient's cirrhosis. Due to economic reasons, the family gave up, asked to be discharged.LessonsIn our report, patients with underlying disease are immunocompromised and at increased risk of infection with conditionally pathogenic bacteria. Nocardia has no specific presentation and is often overlooked clinically. Treatment of these patients should not be limited to common bacteria or viruses, but should consider rare opportunistic pathogens, and we need to be vigilant for Nocardia infections and timely use of sulfonamide antibiotics to reduce mortality.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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