Pulmonary nocardiosis presenting with cardiac tamponade and bilateral pleural effusion in a HIV patient

Nocardiosis induces a high mortality rate in those infected with HIV. It is now being increasingly described in patients with AIDS. Nocardia infection usually involves the lungs. In immunocompromised individuals it tends to disseminate. It mimics pulmonary TB both clinically and radiologically and many a time is wrongly treated with anti-tubercular drugs. Involvement of the pericardium is uncommon, having only been reported infrequently in the past. We describe a patient who presented with a cardiac tamponade and was confirmed as having pulmonary parenchymal and pleural disease.