Breathless and dizzy!—disseminated Nocardia farcinica complicating renal transplantation

A 39-year-old man presented with a 2-week history of increasing shortness of breath and fever. He had reached end-stage renal disease due to autosomal dominant polycystic kidney disease, and had received a transplant from his brother 18 months previously. His post-transplant course was uncomplicated, and graft function at 3 months was excellent with a glomerular filtration rate (GFR) of 110ml/min. He rarely attended subsequent review appointments and his immunosup-pressive regimen at the time of presentation was prednisolone 20mg daily, tacrolimus 2mg twice daily and mycophenolate mofetil, 1 g twice daily. On examination he was found pyrexic (38.18C), mildly hypoxic with oxygen saturations of 92 % on room air, and there were reduced breath sounds a