PMC8819730_01
CT scanning and microbiological identification of case 1. (A) Gram staining of BALF showing Gram-positive, filamentous branching bacilli (magnification, x100). (B) Modified acid-fast staining of BALF showing filamentous, weakly acid-fast branching bacilli (magnification,x100). (C) Colonies of N.cyriacigeorgica cultured on blood agar for 72h. (D) Gram staining showing the Gram-positive, filamentous branching and beaded structure of N.cyriacigeorgica (magnification,x100). (E) Modified acid-fast staining showing filamentous, weakly acid-fast branching bacilli (magnification,x100). (F) Chest CT showing consolidation in the left lower lobe with left-sided pleural effusion. (G) Chest CT showing left-sided pleural effusion. (H) Chest CT showing consolidation in the left lower lobe disappeared following treatment. (I) Chest CT showing left-sided pleural effusion disappeared following treatment.
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Chest computed tomography (CT) scan revealed cord-like high-density shadows in both lungs and consolidation in the left lower lobe with left-sided pleural effusion ( Figure 1 ). Bronchoscopy showed white purulent mucus found on the left lower bronchi ( Supplementary Figure S1 ). Bronchoalveolar lavage fluid (BALF) showed branched neutrophilia, and the Gram staining and modified acid-fast staining revealed filamentous, beaded, branching bacilli ( Figure 1 ). Figure S2 ). Further investigations of the disseminated infection, including brain CT ( Supplementary Figure S1 ) and blood culture, were negative.
Treatment flow diagram of case 1. TMP-SMX, trimethoprim-sulfamethoxazole; SCF, cefoperazone/sulbactam.
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Figure S2 ). Further investigations of the disseminated infection, including brain CT ( Supplementary Figure S1 ) and blood culture, were negative. She was discharged on a 6-month course of oral TMP-SMX therapy after 20 days of hospitalization.  Figure 2  shows the treatment flow diagrams of the case.
PMC8819730_02
Gender and age distribution of nocardiosis with nephrotic syndrome. (A) Gender distribution of patients. (B) Age distribution of patients.
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Chest CT revealed multiple flake and cord-like high-density shadows in both lungs near the pleura, multiple cavities in the right upper lobe, bilateral pleural effusion, and emphysema in both lungs ( Supplementary Figure S3 ). A follow-up chest CT revealed the reduced size of the previously detected cavities ( Supplementary Figure S3 ) and improved clinical symptoms after 21-day hospitalization.
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