Correct!
4. 1 and 3

Nocardiosis is not uncommon in immunocompromised hosts (3). Most are associated with pneumonia which often disseminates in the blood and lymph to the lymph nodes, skin, and/or brain. Although she had no symptoms or physical findings, a brain MRI was performed because of the likelihood of finding a brain abscess (Figure 4).

Figure 4. Representatives images from brain MRI. Not the multiple lesions most prominently seen in the right frontal cortex.

The patient was continued on the sulfamethoxazole-trimethoprim. Prolonged, probably life-long, therapy is planned. The patient slowly improved. A follow up chest x-ray showed the pneumonia to be mostly resolved.

References

  1. Ahuja NK, Clarke JO. Evaluation and Management of Infectious Esophagitis in Immunocompromised and Immunocompetent Individuals. Curr Treat Options Gastroenterol. 2016 Mar;14(1):28-38. [CrossRef] [PubMed]
  2. Letourneau AR, Issa NC, Baden LR. Pneumonia in the immunocompromised host. Curr Opin Pulm Med. 2014 May;20(3):272-9. [CrossRef] [PubMed]
  3. Martínez R, Reyes S, Menéndez R. Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med. 2008 May;14(3):219-27. [CrossRef] [PubMed]

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