Pulmonary nocardiosis owing to Nocardia otitidiscaviarum

Among the nocardial species, Nocardia otitidiscaviarum (formerly Nocardia caviae) as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals. We report 2 renal transplant recipients presenting with pleural effusion and acute respiratory distress syndrome owing to N. otitidiscaviarum. Culture of bronchial washings led to the diagnosis in both the cases and established importance of early bronchoscopy in diagnosing opportunistic pulmonary infections in immunocompromised individuals. Severe side effects of trimethoprim-sulfamethoxazole (TMP-SMX) in both the cases suggest the need to evolve safe and effective alternate drug regimens to treat nocardiosis.