Invited Commentary on Treatment of Nocardia wallacei in an HIV Patient With Renal Failure

This is a case report of an HIV positive patient who was successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) for pulmonary nocardiosis in the setting of acute renal failure. TMP-SMX has been considered a mainstay of nocardiosis treatment for many years, although its use has traditionally been limited in the context of renal impairment. Alternative regimens have been shown to be effective in many cases of nocardiosis, although in our patient who developed acute kidney failure requiring dialysis his clinical status did not improve with other therapies. TMP-SMX ultimately was shown to be the most effective treatment and despite its risk of renal toxicity, the patient recovered renal function. This case also highlights the importance of early and aggressive treatment of nocardiosis to prevent invasive disease in immunocompromised individuals.