Bittar et al. Journal of Medical Case Reports 2010, 4:84 http://www.jmedicalcasereports.com/content/4/1/84 Page 2 of 5 Figure 1 Phylogenetic tree showing the position of N. farcinica (isolate 7400458, GenBank accession number EU861514) in bold and underlined within other Nocardia species. The tree was based on 16S rDNA comparison (1441 bp) using the neighbor-joining method from MEGA 4.0 software. rifampicin, erythromycin, gentamycin, doxycycline, tri- methoprim/sulfamethoxazole and vancomycin. Mean- while, we found it susceptible to amoxicillin, imipenem and ciprofloxacin. Our patient subsequently received a three-week course of intravenous ciprofloxacin, amikacin, and trimetho- prim-sulfamethoxazole. One month later, his leukocyte count decreased to 6.4 × 109/L (50% PMNs), the culture was found negative, and our patient was declared clini- cally cured. During a follow-up examination after one year, N. farcinica was cultured four, six and nine months later and was not cultured at two and three months and one year later. In December 2007, our patient was started on a six-month course of trimethoprim and sulfamethoxa- zole (160/800 mg, 1.5 tablets, b.i.d.) and nebulized amikacin (500 mg, b.i.d., one month/two during six months) in order to eradicate the bacterium. How- ever, because of the difficulty in isolating Nocardia species in sputum samples, as well as the poor sensi- tivity of the culture method, we decided to investigate retrospectively all sputum samples available for our patient using a more sensitive assay (molecular detec- tion). For this purpose we used a specific putative non-ribosomal peptide synthetase sequence [4,5] to develop an original real-time PCR assay with