Nocardial infection in a renal transplant recipient on tacrolimus and mycophenolate mofetil

Infection with Nocardia spp. is an uncommon but important cause of morbidit y and mortality in organ transplant recipients. Cotrimoxazole prophylaxis a gainst urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection oc curred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, mon potent and more diabetogenic immunosuppressive regim ens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.