Nocardiosis: An opportunistic infection in A patient with systemic lupus erythematosus

Nocardiosis is a uncommon opportunistic infection but has been increasingly recognized in patients with systemic lupus erythematosus (SLE). It is important because it is curable but still causes high mortality, which is usually contributed by delayed diagnosis and treatment. A high index of suspicion, an aggressive attitude in diagnosis, and early adequate therapy are necessary for management of nocardiosis in SLE. We report a 45-year-old woman with SLE who presented intermittent high fever, productive cough and general weakness. Initially, pulmonary tuberculosis was considered and antituberculous regimen was started. However, her symptoms did not subside by this regimen for one month. Repeated pleurocentesis yielded pus, and smear/cultures confirmed the diagnosis of nocardiosis. The patient received adequate antibiotic therapy in addition to adjunctive surgical drain for her empyema, and ended up with complete recovery.