case_images: PMC3885780_01
case_images: (A) Both chest radiograph (A) and computed tomography scan of the thorax (B) demonstrate bilateral pleural effusions.
case_images: alm-34-71-g001.jpg
case_images: PMC3885780_01_alm-34-71-g001.jpg
case_images: F1
case_images: Chest radiography revealed a pleural effusion on the right side (Fig. 1A). Chest computed tomography (CT) scan with contrast showed pleural effusion of both lungs with pleural thickening (Fig. 1B).
case_images: Colony morphology on sub-inoculation and microscopic morphology. (A) Chalky-white colonies on blood agar plates at 36C in 5% CO2. (B) Beaded, branching, gram-positive rods of N. cyriacigeorgica (modified acid-fast bacilli stain, x400).
case_images: alm-34-71-g002.jpg
case_images: PMC3885780_01_alm-34-71-g002.jpg
case_images: F2
case_images: On day 23, pleural fluid cultures on sheep blood agar plates (BAP) grew rough, chalky-white colonies with an earthy odor; the presence of abundant thin, modified acid-fast, and gram-positive branching filaments was observed on microscopic examination (Fig. 2).
case_images: Molecular phylogenetic tree constructed by the neighbor-joining method by using (A) 16s rRNA and (B) secA1 gene sequences from the N. cyriacigeorgica isolate and various Nocardia species. Reference sequences indicating the species strain and accession numbers are given in parentheses. All names and accession numbers are as cited in GenBank. Scale bar represents 5 nucleotide substitutions per 1,000 nucleotides.
case_images: alm-34-71-g003.jpg
case_images: PMC3885780_01_alm-34-71-g003.jpg
case_images: F3
case_images: The tree is drawn to scale, with branch lengths in the same units as those of the evolutionary distances used to infer the phylogenetic tree (Fig. 3).