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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Computed tomography of chest reveals new cavitary nodules in the right lower lung&#46; The right lower lung cavitary lesion &#40;yellow arrow&#41; is adjacent to a bronchus &#40;yellow carrot&#41;&#46; &#40;B&#41; Convex-probe endobronchial ultrasound image of thickened cavitary wall &#40;yellow asterisk&#41; of right lower lobe opacity&#46; &#40;C&#41; Gomori Methenamine-Silver nitrate statin &#40;A&#44; 600&#215;&#41; highlights the branching gram-positive filamentous organisms&#46; &#40;D&#41; <span class="elsevierStyleItalic">Nocardia</span> is weakly acid-fast&#44; and FITE &#40;B&#44; 600&#215;&#41; stain&#44; which is a modified acid fast stain&#44; is positive with the branching filamentous organism&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A middle-aged man with chronic lymphocytic leukemia status post hematopoietic stem cell transplantation &#40;day 210&#41; was admitted with diarrhea&#46; His clinical course was complicated with skin and gastrointestinal &#40;grade IV&#41; graft-versus-host disease&#46; He was maintained on antimicrobial &#40;valacyclovir&#44; levofloxacin&#44; atovaquone&#44; isavuconazonium&#41; and immunosuppressive therapy &#40;tacrolimus&#44; methylprednisolone&#44; sirolimus&#44; ruxolitinib&#44; vedolizumab&#44; extracorporeal photopheresis&#41;&#46; He developed a dry cough&#44; and a computed tomograpy &#40;CT&#41; scan of the chest revealed 2 cavitary opacities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Cavitary lesions were thick walled and located in the right lower lobe and left upper lobe without associated parenchymal lesions&#46; Given its proximity to the airway&#44; in addition to a bronchoalveolar lavage &#40;BAL&#41;&#44; convex-probe-endobronchial ultrasound &#40;c-EBUS&#41; guided transbronchial needle aspiration &#40;TBNA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; was performed&#46; Cytology revealed gram-positive filamentous branching rods later on identified as <span class="elsevierStyleItalic">Nocardia kruczakiae</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C &#38; D&#41;&#46; Additional anti-bacterial therapy was initiated&#46; Unfortunately&#44; clinical course was complicated by gastrointestinal bleeding&#44; and he passed away 2 months later&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Nocardia</span> is an opportunistic gram-positive organism notorious for its ability to invade any organ&#44; and lungs and the central nervous system are frequently affected&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Inhalation is the typical route of infection&#44; but inoculation and transmission from the gastrointestinal tract are also reported&#46; Pulmonary nocardiosis occurs most frequently in immunocompromised patients&#44; and risk factors include diabetes&#44; organ transplantation&#44; use of steroids and calcineurin inhibitor&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Radiographic presentation may vary and includes consolidation&#44; nodules&#44; cavities and masses&#44; and these are typically mistaken for fungal infection or malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> In our case&#44; BAL and EBUS-TBNA confirmed <span class="elsevierStyleItalic">Nocardia</span>&#44; and cytology facilitated prompt diagnosis&#46; In those with acceptable hematologic parameters and accessible lesions&#44; EBUS-TBNA may be a helpful adjunct to BAL as a diagnostic tool&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">BP&#44; AS&#44; SAF&#58; conception and design&#44; acquisition of radiological and pathological data&#44; drafting the article&#44; critical revision of intellectual content and final approval of the version to be published</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research is supported in part by the National Institutes of Health through <span class="elsevierStyleGrantSponsor" id="gs1">MD Anderson&#39;s Cancer Center Support Grant</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">CA016672</span>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no conflicts of interest exist</p></span></span>"
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