Human
nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The
infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term
corticosteroid treated patients. Currently the widespread use of
immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of
nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of
nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of
nocardiosis associated with anti-
tumor necrosis factor (TNF) prescription (9 related with
infliximab and 2 with
adalimumab) were identified; 7 patients had
inflammatory bowel disease (IBD), 4 had rheumatological conditions;
nocardia infection presented as cutaneous involvement in 3 patients,
lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with
steroids and
azathioprine. In conclusion,
nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting
immunomodulators or anti-TNF after the disease or the value of prophylaxis with
cotrimoxazole is still debated.