NOCARDIOSIS IN RENAL-TRANSPLANT RECIPIENTS UNDERGOING IMMUNOSUPPRESSION WITH CYCLOSPORINE

Nine cases of nocardiosis were diagnosed among 1,255 renal transplant recipients given cyclosporine (CsA)-prednisone for immunosuppression between August 1980 and March 1992 (incidence, 0.7%). Of these nine patients presenting with nocardiosis 32-1,806 days after transplantation, eight had pulmonary involvement, two had skin manifestations (one with localized disease), and one had a cerebral abscess and a pleural effusion. All cases required aggressive diagnostic procedures. Nocardia asteroides was isolated in seven cases and Nocardia brasiliensis in two. All but one case was cured. Included among the cures were all of four cases treated with amoxicillin/clavulanic acid. Therapy with CsA-prednisone was continued throughout the infection in eight cases. Analysis of a group of 154 historical controls who received azathioprine (AZA)-prednisone for immunosuppression after renal transplantation (performed before 1980 at the same center) revealed four cases of nocardiosis (incidence, 2.6%). Thus nocardiosis is apparently less common among renal transplant recipients given CsA-prednisone than among those given AZA-prednisone. The clinical presentation of nocardiosis in renal transplant recipients is variable, with pulmonary involvement predominating. Diagnosis requires an aggressive approach. Chemotherapy is successful in most cases, including those treated with amoxicillin/clavulanic acid when the isolate is susceptible.