Nocardia farcinica pneumonia in chronic granulomatous disease

Infection with Nocardia poses a diagnostic challenge in patients with chron ic granulomatous disease (CGD) because the signs and symptoms are often non specific, delay in diagnosis is common, and invasive procedures are frequen tly required to obtain appropriate tissue specimens. We present the first r eported case of N farcinica pneumonia in an adolescent with X-linked CGD. D ifferentiation of N farcinica from other members of N asteroides complex is important because of its propensity for causing disseminated infection and antimicrobial resistance. Physicians caring for patients with CGD should m aintain a high index of suspicion for nocardiosis, especially in those rece iving chronic steroid therapy. Early diagnosis remains critical for decreas ed morbidity and occasional mortality.