Snapshot A 26-year-old female with HIV presents to the primary care clinic with a four month history of fever, night sweats, and a cough productive of yellow sputum. She is PPD negative and CD4+ count is 320 cells/μL blood. Chest radiograph reveals pulmonary cavitations confirmed by CT scan of the chest. Sputum is negative for AFB. Bronchoscopy was carried out and a modified Ziehl-Neelsen stain of the aspirate revealed partially acid fast gram-positive filamentous rods. Introduction Classification bacteria fungus-like bacteria Nocardia N. asteroides N. brasiliensis Presentation Pulmonary nocardiosis cavitary pulmonary disease frequently misdiagnosed as TB immunocompromised patients are at risk can spread hematogenously to brain causing brain abscesses mostly caused by. N. asteroides Cutaneous nocardiosis cellulitis with draining abscesses mostly caused by N. brasiliensis via traumatic implantation Evaluation Definitive diagnosis made with culture and Gram-stain Partially acid fast Differential Chest manifestations of AIDS pulmonary TB Pneumocystis jiroveci pneumonia coccidioidomycosis Treatment Sulfonamides or TMP-SMX "SNAP" = Sulfa for Nocardia; Actinomyces use Penicillin Prognosis, Prevention, and Complications Prognosis patient tends to relapse despite appropriate therapy requires prolonged treatment regimens Prevention maintainance-suppressive therapy for immunosuppressed patients TMP-SMX and doxycycline can be used Complications mycetoma disseminated infection