Bittar et al. Journal of Medical Case Reports 2010, 4:84 http://www.jmedicalcasereports.com/content/4/1/84 as proven by our new real-time PCR that appears more sensitive than culture (Figure 2). In the case reports of Isabel Barrio et al., [9], six of 9 patients (67%) with Nocardia species isolations had clinical manifestations, while the Nocardia species were repeatedly isolated 3 patients. After a mean follow-up at 48 ± 33 months, however, the cultures were negative for all of the patients studied. N. farcinica infections are potentially life-threatening [6,11]. The complete genome sequence of a clinical isolate (N. farcinica IFM 10152) revealed the presence of many candidate genes for virulence and antibiotic resistance [5]. After conducting a genomic analysis, the authors suggested that this bacterium can survive not only in soil environment but also in animal tissues, thus resulting in human disease [5]. It is now known N. farcinica is a multidrug-resistant bacterium that is susceptible mainly to amikacin, imipenem, trimetho- prim/sulfamethoxazole, and ciprofloxacin [6]. Isolates from our patient were resistant to trimethoprim/ sulfamethoxazole. Cases involving N. farcinica that is resistant to trimethoprim/sulfamethoxazole have been described previously [5,12]. Chronic lung colonization in our patient, which was demonstrated by his positive PCR assay, indicates that antibiotic treatment does efficiently and completely eradicate the bacterium. In two recent case reports, the authors indicate that the need for Nocardia treatment should be evaluated on an individual basis and in the context of a clinical picture [9,10]. We believe that Nocardia eradication is needed in patients with CF, especially if they are due to undergo lung transplantation. The reason for this is that the immunosuppressive regimen during the pre- and/or post-operative period is a well- established risk factor for serious cases of nocardiosis and disseminated disease that leads to high rate of mortality [13]. The impact of the presence of multiresistant patho- gens on the survival of patients with CF after lung trans- plantation remains controversial [14,15]. In the case of nocardiosis in patients with CF, no recommendations or data appear in the literature. Conclusion We reported a case of lung infection followed by chronic colonization of trimethoprim-sulfamethoxazole resistant N. farcinica in a patient with CF. Our case report confirms that this infrequent organism can be recovered in such a population. We think that this unusual bacterium could be the cause of major clinical concern for patients with CF when immunosuppressive treatment is needed in cases requiring lung transplantation. Page 4 of 5 Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations CF: cystic fibrosis; CNA: Columbia colistin-nalidixic acid; CRP: C-reactive protein; PMNs: polymorphonuclear cells. Author details 1Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS-IRD, UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Boulevard Jean Moulin, 13385 Marseille cedex 5, France. 2Département des Maladies Respiratoires, Centre de Ressources et de Compétences pour la Mucoviscidose (CRCM), Hôpital Timone, Marseille, France. 3Laboratoire de Bactériologie, Centre Hospitalier, Boulevard des Rayettes, 13698 Martigues CEDEX, France. Authors’ contributions FB collected the data and drafted the manuscript. NS, JPA, JCD and JS took care of our patient during his hospitalization. DR and JMR participated in the design and critical revision of the study and helped draft the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 4 November 2009 Accepted: 8 March 2010 Published: 8 March 2010 References 1. Saiman L, Siegel J: Infection control in cystic fibrosis. Clin Microbiol Rev 2004, 17:57-71. 2. Lyczak JB, Cannon CL, Pier GB: Lung infections associated with cystic fibrosis. Clin Microbiol Rev 2002, 15:194-222. 3. Weisburg WG, Barns SM, Pelletier DA, Lane DJ: 16S ribosomal DNA amplification for phylogenetic study. J Bacteriol 1991, 173:697-703. 4. Brown JM, Pham KN, McNeil MM, Lasker BA: Rapid identification of Nocardia farcinica clinical isolates by a PCR assay targeting a 314- base-pair species-specific DNA fragment. J Clin Microbiol 2004, 42:3655-3660. 5. 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