Nocardiosis mimicking pulmonary tuberculosis in Ugandan AIDS patients [letter]

ABSTRACT

cases of nocardiosis were diagnosed post-mortem in Ugandan men who died of AIDS, erroneously diagnosed and treated for sputum-negative pulmonary tuberculosis. A 38-year old policeman hospitalized for productive cough, hemoptysis, fever, chest pain, and weight loss, had right lung consolidation and pleural effusion, as well as Kaposi's sarcoma. His sputum was negative for acid-fast bacilli, but he was diagnosed and treated for pulmonary tuberculosis. He died 26 days after admission. He had disseminated Kaposi's sarcoma, severe candidiasis, and consolidation and caseous necrosis of both lungs. Nocardia filaments were apparent on silver and modified acid-fast staining. A 41-year old man, also admitted with productive cough, chest pain, and weight loss, had normal lungs on admission. Despite a negative sputum, he was also diagnosed and treated for HIV and pulmonary tuberculosis, but died 5 days later. At autopsy there was consolidation of both lungs, and cultures grew Nocardia asteroides. Since nocardiosis is curable, it should be considered in Africa, as well as Western countries, as a differential diagnosis of tuberculosis in an HIV-infected patient with respiratory symptoms