Abstract: SA-PO1003
Unearthing Trouble: Concomitant Soilborne Infections in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Xu, Michael, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Szumel, Elizabeth Salisbury, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Rudloff, Michael W, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Jain, Koyal, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Introduction
Nocardia nova and Purpureocillium lilacinum are soilborne opportunistic pathogens. As the number of immunocompromised organ transplant recipients increases, the incidence of opportunistic infections is also increasing. We present a rare case of concomitant Nocardia nova and Purpureocillium lilacinum infection in a kidney transplant recipient.
Case Description
A 66-year-old female with end-stage kidney disease due to focal segmental glomerulosclerosis, status post deceased-donor kidney transplant on immunosuppression, presented with left-sided weakness. Brain MRI showed a ring-enhancing right parietal lobe lesion with edema (Figure 1A). CT chest showed a perihilar right upper lobe lesion with calcified lymph nodes (Figure 1B). Linezolid and imipenem were empirically started after Gram stains of bronchoalveolar lavage (BAL) samples showed Gram-positive bacilli.
On hospital day 3, the patient’s left-sided weakness acutely worsened. Another brain MRI showed worsening edema, for which a brain biopsy and abscess washout were performed. Given concern for disseminated fungal infection, voriconazole was empirically started. BAL cultures grew Nocardia nova and mold that speciated as Purpureocillium lilacinum. The brain biopsy cultures grew Nocardia nova. The patient’s neurologic deficits gradually improved with linezolid, imipenem, and voriconazole.
Discussion
In this case, a detailed history revealed that the patient worked on a dairy farm and frequently gardened, exposing her to aerosolized spores and mycelial fragments from perturbed soil. For immunosuppressed patients, a thorough history that includes their hobbies and professions is critical for identifying sources of infection. Counseling about the risks of outdoor activities will be key to decreasing morbidity in transplant patients.
Figure 1A: MRI brain with a right parietal lobe ring-enhancing lesion that grew Nocardia nova.
Figure 1B: CT chest with a right upper lobe lesion with calcified lymph nodes. BAL cultures grew Nocardia nova and Purpureocillium lilacinum.