[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-454885-105":59,"doc-detail-454885-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","pulmonary-nocardiosis-in-an-immunocompetent-host-a-diagnostic-challenge-requiring-multimodal-evaluation","Pulmonary Nocardiosis in an Immunocompetent Host - A Diagnostic Challenge Requiring Multimodal Evaluation","","Pulmonary nocardiosis is a rare opportunistic infection that typically targets immunocompromised hosts, yet it can also occur in immunocompetent individuals with chronic lung disease, where it can closely mimic other conditions. The case describes a 72-year-old woman with pulmonary fibrosis and progressive pneumonia unresponsive to standard therapy. Multiple bronchoscopy attempts were non-diagnostic until EBUS-TBNA from a mediastinal lymph node confirmed Nocardia species. The report emphasizes high diagnostic suspicion and the value of multimodal invasive evaluation to enable timely, targeted treatment.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pulmonary-nocardiosis-in-an-immunocompetent-host-a-diagnostic-challenge-requiring-multimodal-evaluation/454885/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pulmonary-nocardiosis-in-an-immunocompetent-host-a-diagnostic-challenge-requiring-multimodal-evaluation/454885.png","ImageObject",300,407,{"name":92,"@type":93},"Stanford","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is pulmonary nocardiosis difficult to diagnose in immunocompetent patients?","Question",{"text":113,"@type":114},"Symptoms are often subacute and can overlap with exacerbations of chronic lung disease and other infections, so clinicians need a high index of suspicion.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What diagnostic step ultimately confirmed the Nocardia species in this case?",{"text":118,"@type":114},"Cultures obtained from an endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a mediastinal lymph node confirmed Nocardia species after multiple non-diagnostic bronchoscopies.",{"name":120,"@type":111,"acceptedAnswer":121},"What patient factors and clinical course in the report increased concern despite standard therapy?",{"text":122,"@type":114},"A 72-year-old woman with pulmonary fibrosis had progressive pneumonia that did not respond to standard antimicrobial treatment, and she was not taking immunosuppressive medications, prompting broader invasive and multimodal evaluation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},454885,1790792178,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Review began 11/18/2025  \nReview ended 12/03/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nOke et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98695  \nOpen Access Case Report  \nPulmonary Nocardiosis in an Immunocompetent Host: A Diagnostic Challenge Requiring Multimodal Evaluation  \nVikram Oke 1, Seerut Dhillon 2, Michelle Ju 2, Robert Tilley 1, Karthik Iyer 3  \n1. Pulmonary and Critical Care Medicine, Mercy Hospital Jefferson, Festus, USA 2. Internal Medicine, Mercy Hospital Jefferson, Festus, USA 3. Critical Care Medicine, Mercy Hospital Jefferson, Festus, USA  \nCorresponding author: Vikram Oke, [vikramoke@gmail.com](vikramoke@gmail.com)  \nAbstract  \nPulmonary nocardiosis is a rare opportunistic infection usually affecting immunocompromised hosts but can present in immunocompetent individuals with chronic lung disease, creating diagnostic challenges. We describe the case of a 72-year-old woman with pulmonary fibrosis who had progressive pneumonia unresponsive to standard therapy. Despite multiple non-diagnostic bronchoscopies, cultures from an endobronchial ultrasound-guided transbronchial needle aspiration of a mediastinal lymph node ultimately confirmed Nocardia species. This case underscores the importance of considering nocardiosis in nonresolving pneumonia among immunocompetent patients and highlights the role of multimodal, invasive diagnostics in establishing a timely diagnosis and guiding targeted therapy.  \nCategories: Internal Medicine, Infectious Disease, Pulmonology  \nKeywords: bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration (ebus-tbna), immunocompetent, multimodal diagnosis, nocardia cyriacigeorgica, opportunistic infection, pulmonary fibrosis, pulmonary nocardiosis  \nIntroduction  \nPulmonary nocardiosis is a rare but potentially serious opportunistic infection caused by Nocardia species.  \nNocardia spp. are aerobic, filamentous, partially acid-fast, gram-positive bacteria found primarily within soil, decaying organic matter, and water [1,2] . The most common form of nocardiosis is associated with pulmonary involvement, typically resulting from inhalation of the bacteria [3] . Nocardiosis most commonly affects immunocompromised individuals, including those with malignancies, solid organ transplant recipients, on chronic corticosteroid therapy, or those with a history of human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) [1,4] . Over one-third of these infections occur in immunocompetent hosts, particularly in chronic lung diseases such as chronic obstructive pulmonary disease or bronchiectasis [3,5] . Pulmonary nocardiosis is difficult to diagnose as symptoms are subacute and overlap with chronic lung disease exacerbations and other infections. The diagnosis requires a high index of suspicion, especially in immunocompetent patients. We present a diagnostically challenging case of pulmonary nocardiosis in an immunocompetent patient with pulmonary fibrosis. The diagnosis required multiple invasive diagnostic modalities, including repeat bronchoscopies, with endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) of a mediastinal lymph node ultimately providing confirmation.  \nCase Presentation  \nA 72-year-old woman with a history significant for pulmonary fibrosis and chronic kidney disease (CKD) presented to the emergency department (ED) with bilateral pleuritic chest pain, productive cough, fevers, diarrhea, and generalized weakness. She had a 10-pack-year smoking history but quit 40 years prior. Five days before presentation, her primary care physician empirically treated her with azithromycin for presumed community-acquired pneumonia, but her symptoms worsened, prompting ED referral. A revi","cbCaifRFs9TzWHau","https://ap.wps.com/l/cbCaifRFs9TzWHau","pdf",2564815,"English","# Abstract\n# Introduction\n# Case Presentation","[{\"question\":\"Why is pulmonary nocardiosis difficult to diagnose in immunocompetent patients?\",\"answer\":\"Symptoms are often subacute and can overlap with exacerbations of chronic lung disease and other infections, so clinicians need a high index of suspicion.\"},{\"question\":\"What diagnostic step ultimately confirmed the Nocardia species in this case?\",\"answer\":\"Cultures obtained from an endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a mediastinal lymph node confirmed Nocardia species after multiple non-diagnostic bronchoscopies.\"},{\"question\":\"What patient factors and clinical course in the report increased concern despite standard therapy?\",\"answer\":\"A 72-year-old woman with pulmonary fibrosis had progressive pneumonia that did not respond to standard antimicrobial treatment, and she was not taking immunosuppressive medications, prompting broader invasive and multimodal evaluation.\"}]","Pulmonary Nocardiosis in an Immunocompetent Host - A Diagnostic Challenge Requiring Multimodal Evaluation | PDF",1790741614,18]