Nocardiosis is prevalent among individuals with immunodeficiency or long-term use of immunosuppressive agents. However, in one third of cases, it can occur in immunocompetent patients [1]. Nocardia infections in immunocompetent patients represent a diagnostic challenge given the clinical and radiological similarity with infectious diseases and neoplasms [2]. We present the case of a Nocardiacyriacigeorgica pneumonia in an immunocompetent patient who had no history of immunosuppressive agent use, signs of immunodeficiency, or any concomitant diseases. In Italy, cases of Nocardia cyriacigeorgica infection are rarely reported in the literature, likely due to challenges in microbiological isolation and identification of this microorganism.
References
[1]
González-Jiménez, P., Méndez, R. and Latorre, A. (2022) Pulmonary Nocardiosis. A Case Report. Revista Española de Quimioterapia, 35, 114-116. https://doi.org/10.37201/req/s01.24.202
[2]
Garcia Rueda, J.E., García Rueda, K.Y., Bermúdez Flórez, A.M., Peña Mejía, L.A., Cardona Palacio, A. and Castaño Ruiz, W. (2024) Nocardia in an Immunocompetent Patient Simulating Pulmonary Carcinoma: A Case Report and Literature Review. Cureus, 16, e64491. https://doi.org/10.7759/cureus.64491
[3]
Schlaberg, R., Huard, R.C. and Della-Latta, P. (2008) Nocardia cyriacigeorgica, an Emerging Pathogen in the United States. Journal of Clinical Microbiology, 46, 265-273. https://doi.org/10.1128/jcm.00937-07
[4]
Witebsky, F.G., Conville, P.S., Wallace, R.J. and Brown-Elliott, B.A. (2008) Nocardia cyriacigeorgica—An Established Rather than an Emerging Pathogen. Journal of Clinical Microbiology, 46, 2469-2470. https://doi.org/10.1128/jcm.00510-08
[5]
Gutiérrez, C., Céspedes, A., Legarraga, P., Morales, P. and Chanqueo, L. (2020) Nocardia cyriacigeorgica Infection in AIDS Patient. RevistaChilena de Infectología, 37, 322-326. https://pubmed.ncbi.nlm.nih.gov/32853327/
[6]
Yang, J., Ren, H., Wang, J., Dong, A., Chen, Y., Hu, D., et al. (2023) Clinical Characteristics, Susceptibility Profiles, and Treatment of Nocardiosis: A Multicenter Retrospective Study in 2015-2021. International Journal of Infectious Diseases, 130, 136-143. https://doi.org/10.1016/j.ijid.2023.02.023
[7]
Yagi, K., Ishii, M., Namkoong, H., Asami, T., Fujiwara, H., Nishimura, T., et al. (2014) Pulmonary Nocardiosis Caused by Nocardia cyriacigeorgica in Patients with Mycobacterium aviumcomplex Lung Disease: Two Case Reports. BMC Infectious Diseases, 14, Article No. 684. https://doi.org/10.1186/s12879-014-0684-z
[8]
Lin, J., Wu, X. and Peng, M. (2021) Nocardia cyriacigeorgica Infection in a Patient with Pulmonary Sequestration: A Case Report. World Journal of Clinical Cases, 9, 2367-2372. https://doi.org/10.12998/wjcc.v9.i10.2367
[9]
Wang, H., Zhu, Y., Cui, Q., Wu, W., Li, G., Chen, D., et al. (2022) Epidemiology and Antimicrobial Resistance Profiles of the nocardia Species in China, 2009 to 2021. Microbiology Spectrum, 10, e01560-21. https://doi.org/10.1128/spectrum.01560-21
[10]
Lima, M.R., Garcia, E., Siebeneichler, A., et al. (2016) Pulmonary Infection by a Negative Acid-Fast Bacilli NocardiaCyriacigeorgica in a Patient with Bronchiectasis and Past (History of Tuberculosis (TB). Chest Infections, 149, A106. https://journal.chestnet.org/article/S0012-3692(16)00729-7/fulltext
[11]
Chavez, T.T., Fraser, S.L., Kassop, D., Bowden, L.P. and Skidmore, P.J. (2011) Disseminated Nocardia cyriacigeorgica Presenting as Right Lung Abscess and Skin Nodule. Military Medicine, 176, 586-588. https://doi.org/10.7205/milmed-d-10-00346
[12]
Browne, W.D., Lieberson, R.E. and Kabbesh, M.J. (2021) Nocardia cyriacigeorgica Brain and Lung Abscesses in 77-Year-Old Man with Diabetes. Cureus, 13, e19373. https://doi.org/10.7759/cureus.19373
[13]
Saunier, F., Grange, S., Rigaill, J., Lutz, M., Gagneux-Brunon, A. and Botelho-Nevers, E. (2022) Bacteremia and Adrenal Gland Abscess Due to Nocardia Cyriacigeorgica: A Case Report and Review. BMC Infectious Diseases, 22, Article No.966. https://doi.org/10.1186/s12879-022-07839-9
[14]
Khorshidi, M., Navid, S., Azadi, D., Shokri, D. and Shojaei, H. (2018) A Case Report of Brain Abscess Caused by Nocardia cyriacigeorgica in a Diabetic Patient. JMM Case Reports, 5, 1-4. https://doi.org/10.1099/jmmcr.0.005133
[15]
Lee, F.J., Aung, A.K., Pereira, L.A., Arthur, I.H. and Murray, R.J. (2013) Fatal Nocardia cyriacigeorgica Spontaneous Bacterial Peritonitis. New Microbes and New Infections, 1, 32-33. https://doi.org/10.1002/2052-2975.18
[16]
Freiberg, J.A., Saharia, K.K. and Morales, M.K. (2018) An Unusual Case of Nocardia cyriacigeorgica Presenting with Spinal Abscesses in a Renal Transplant Recipient and a Review of the Literature. Transplant Infectious Disease, 21, e13025. https://doi.org/10.1111/tid.13025
[17]
Alshammari, K., Al Hothaly, B. and Alrabiah, F. (202) Case of Nocardia cyriacigeorgica Infection of the Eye in a Granulomatosis with Polyangiitis Patient. Cureus, 12, e11178. https://pubmed.ncbi.nlm.nih.gov/33133800/
[18]
Gabay, S., Yakubovsky, M., Ben-Ami, R. and Grossman, R. (2022) Nocardia cyriacigeorgica Brain Abscess in a Patient on Low Dose Steroids: A Case Report and Review of the Literature. BMC Infectious Diseases, 22, Article No. 635. https://doi.org/10.1186/s12879-022-07612-y
[19]
Lee, J., Whitby, M. and Hall, B.I. (2010) Nocardia cyriacigeorgica Abscess of the Conus Medullaris in an Immunocompetent Host. Journal of Clinical Neuroscience, 17, 1194-1195. https://doi.org/10.1016/j.jocn.2009.12.022
[20]
Rivera, K., Maldonado, J., Dones, A., Betancourt, M., Fernández, R. and Colón, M. (2017) Nocardia cyriacigeorgica Threatening an Immunocompetent Host: A Rare Case of Paramediastinal Abscess. Oxford Medical Case Reports, 2017, 239-241. https://doi.org/10.1093/omcr/omx061
[21]
Kibe, S., Meigh, R., Moon, T., Kastelik, J. and Morjaria, J. (2015) Nocardia cyriacigeorgica in an Immunocompetent Patient. Therapeutic Advances in Respiratory Disease, 9, 28-30. https://doi.org/10.1177/1753465814565352
[22]
Lv, H.Y., Chen, M.Y., Ji, Y.Q., Pan, L.Y., Hong, X. and Ge, Y.M. (2023) A Rare Case of a Subcutaneous Abscess Caused by Nocardia cyriacigeorgica in an Immunocompetent Patient. Infection and Drug Resistance, 16, 263-268. https://pubmed.ncbi.nlm.nih.gov/36660347/
[23]
Daniel, M., Salman, S. and Adam, B. (2024) Disseminated Nocardia cyriacigeorgica Infection Disguised as a Metastatic Adrenal Gland Malignancy in a Healthy Patient. Cureus, 16, e63693. https://pubmed.ncbi.nlm.nih.gov/38957514/ https://doi.org/10.7759/cureus.63693
[24]
Yang, L.N., Wang, W., Sun, X.F., Wang, Y.L. and Sheng, Z.Y. (2024) A Case of Nocardia cyriacigeorgica Endophthalmitis after Intraocular Surgery. Chinese Journal of Ophthalmology, 60, 931-934. https://pubmed.ncbi.nlm.nih.gov/39505380/
[25]
Altan, G., Tabanli, A., Ozgenc, G. and Ece, G. (2024) Primary Brain Abscess Due to Nocardia cyriacigeorgica in a Patient with Renal Transplantation: Case Report. The New Microbiologica, 47, 363-367. https://pubmed.ncbi.nlm.nih.gov/39998402/
[26]
Zuo, H., et al. (2024) Myasthenia Gravis Complicated with Pulmonary Infection by Nocardia cyriacigeorgica: A Case Report and Literature Review. Frontiers in Medicine (Lausanne), 11, Article 1423895. https://pubmed.ncbi.nlm.nih.gov/39416864/
[27]
Koruga, N., et al. (2024) A Rare Case of Cerebellar Abscess Caused by Nocardia cyriacigeorgica. Surgical Neurology International, 15, 413. https://pubmed.ncbi.nlm.nih.gov/39640338/ https://doi.org/10.25259/SNI_426_2024
[28]
Li, Q., Zheng, J., Zhang, Q., Liang, Y., Zhu, H. and Sun, Y. (2024) A Case of Yellow Nail Syndrome Complicated with Pulmonary Infection Due to Nocardia cyriacigeorgica. Infectious Disease Reports, 16, 906-913. https://doi.org/10.3390/idr16050072 https://pmc.ncbi.nlm.nih.gov/articles/PMC11417919/
[29]
Li, Y., et al. (2024) Case Report: Pulmonary Mixed Infection by Nocardia cyriacigeorgica, Stenotrophomonas maltophilia, and Human Cytomegalovirus in a Patient with Minimal Change Nephrotic Syndrome. Frontiers in Immunology, 16, Article 1599958. https://pubmed.ncbi.nlm.nih.gov/40491912/ https://doi.org/10.3389/fimmu.2025.1599958
[30]
Calvo, M., Beunza Sola, M., Tirapu, B., Sarobe Carricas, M. and Moreno, E. (2025) Therapeutic Drug Monitoring of Linezolid in a Case of Pulmonary Nocardiosis: A Case Report. European Journal of Hospital Pharmacy. https://pubmed.ncbi.nlm.nih.gov/39978959/ https://doi.org/10.1136/ejhpharm-2024-004462
[31]
Varda Brkić, D., et al. (2025) Disseminated Infection Caused by Nocardia cyriacigeorgica in Immunocompromised Patient Confirmed by Whole Genome Sequencing. Chemotherapy, 70, 1-8. https://doi.org/10.1159/000539977 https://pubmed.ncbi.nlm.nih.gov/39128464/
[32]
AlMogbel, M., AlBolbol, M., Elkhizzi, N., AlAjlan, H., Hays, J.P. and Khan, M.A. (2020) Rapid Identification of Nocardia cyriacigeorgica from a Brain Abscess Patient Using MALDI-TOF-MS. Oxford Medical Case Reports, 2020, 359-361. https://doi.org/10.1093/omcr/omaa088
[33]
Terlizzi, V., Ballerini, T., Castaldo, A., Dolce, D., Campana, S., Taccetti, G., et al. (2024) Clinical Features and Outcomes of Persons with Cystic Fibrosis and Nocardia Isolation: A Systematic Review. BMC Pulmonary Medicine, 24, Article No. 440. https://doi.org/10.1186/s12890-024-03217-0
[34]
Colaneri, M., Lupi, M., Sachs, M., Ludovisi, S., Di Matteo, A., Pagnucco, L., Gulminetti, R., Mariani, B., Fabbiani, M. and Bruno, R. (2021) A Challenging Case of SARS-CoV-2-AIDS and Nocardiosis Coinfection from the San Matteo Covid-19 Registry (SMACORE). New Microbiologica, 44, 129-134. https://pubmed.ncbi.nlm.nih.gov/34151993/
[35]
Castellana, G., Grimaldi, A., Castellana, M., Farina, C. and Castellana, G. (2016) Pulmonary Nocardiosis in Chronic Obstructive Pulmonary Disease: A New Clinical Challenge. Respiratory Medicine Case Reports, 18, 14-21. https://doi.org/10.1016/j.rmcr.2016.03.004
