Bittar et al. Journal of Medical Case Reports 2010, 4:84 http://www.jmedicalcasereports.com/content/4/1/84 Taqman* probe. The primers designed for this RT PCR were as follows: NFF1 (5’-ACCGATCCGCCGT CAAATC-3’) and NFR1 (5’-TCGGTCGTCCGGTG TGGA-3’) that amplified a 147 bp of this gene with a probe of NFP1 (5’-CACATACCCCAACGCCAGC TGA-3’). The DNA from his sputa was extracted in a MagNa Pure LC instrument (Roche Diagnostics GmbH, Mannheim, Germany) according to the manu- facturer’s instruction. Using our PCR assay, all investigated negative and positive N. farcinica culture sputa were positive in PCR even in sputa recovered one year before the first culture detection (Figure 2). Retrospectively, our patient’s medi- cal record was rechecked as his clinical condition, including cough, haemoptysis, purulent mucoid expec- toration, and elevated CRP and leukocytes (> 80% PMNs) worsened at that stage. Discussion N. farcinica is a Gram-positive branching filamentous bacillus causing many localized and disseminated infections in humans, including pulmonary and wound infections, brain abscesses, and bacteremia [6]. Immuno- compromised hosts and patients undergoing immuno- suppressive therapies are more commonly affected by this bacterium [6], but the isolation of N. farcinica from the respiratory tract of patients with CF is rare. Only Page 3 of 5 three reports described the isolation of this bacillus in patients with CF: the case of a 31-year-old woman with deteriorated clinical parameters [7], the case of an 8-year-old boy who presented with fever and worsened chronic cough and who had previously received corti- costeroid for allergic bronchopulmonary aspergillosis treatment [8], and the case of a 28-year-old woman with cough, dyspnea, fever, and hemoptysis and who had pre- viously received corticosteroid [9]. Interestingly, our patient had a corticosteroid treatment history before the Nocardia isolation. Meanwhile, other Nocardia species have been reported in patients with CF, including N. asteroides, N. asiatica, N. elegans, and N. transvalensis [9,10]. Nocardiae are ubiquitous in the environment and can be found worldwide in fresh and salt water, in a variety of soil types, dust, decaying vegetation, and decaying fecal deposits from animals [6]. Dasgupta et al. described a patient who was an active gardener [7]. Interestingly, our patient also worked as a gardener, which led us to conclude that he might have acquired the infection in his job. The first isolation of N. farcinica in our case was asso- ciated with clinical symptoms including fever, haemop- tysis, bronchial syndrome, and multiple bilateral bronchial thickening and radiographic change. Our patient was then chronically colonized with this bacillus Figure 2 Nocardia farcinica DNA detection in different sputa recovered from the patient according the number of months and antibiotic treatment. Month 0 = January, 2006. Blue point = Nocardia farcinica positive culture. Tri-SMX = trimethoprim-sulfamethoxazole.