Medical Case Reports

Pneumonia Amidst the COVID-19 Pandemic: A Diagnostic Perplexity

Pulmonary nocardiosis is a subacute or chronic necrotizing pneumonia caused by aerobic actinomycetes of the genus nocardia and rare in immune-competent patients. Clinical diagnosis of pulmonary nocardiosis is difficult owing to the similarity of its presentation with other respiratory pathogens that include actinomycetes members and Mycobacterium tuberculosis. Laboratory diagnosis of human nocardiosis is plagued by the fact that a culture of Nocardia spp requires prolonged incubation periods for isolation which most laboratories fail to follow. The lack of clinical, laboratory and epidemiological data on the incidence of nocardiosis in humans undermines its significance as a potential pathogen. Here we present a case of pulmonary nocardiosis in an elderly gentleman who presented with similar features of Covid 19 who on further evaluation was found to have pulmonary nocardiosis. The patient had a past history of diabetes and myasthenia gravis on mycophenolate mofetil. Though nocardiosis is commonly seen in immunocompromised patients, the challenges we faced were diagnosing a case with similar radiological features of Covid 19 pneumonia and the difference in management strategies of the two. 

Author(s): Arushi Mohan, Abhinaya Shekhar ,Brunda MS and Prakash Doraiswamy

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