Successful treatment of tuberculous and nocardial arthritis in a hemodialysis patient with subsequent kidney transplant.

A 42-year-old physician on maintenance hemodialysis for chronic renal failure presented with intermittent fever and arthritis of the right knee. Synovectomy specimen of the right knee showed caseating granuloma, consistent with tuberculosis, which was successfully treated with a four-drug regimen of anti-tuberculous therapy. Subsequently, he had a recurrent effusion of the same joint, which on aspiration showed nocardial infection. He was treated with a combination therapy (sulfamethoxazole-trimethoprim and amoxicillin) for four months. He underwent a successful living-related transplant two months later, and was doing well on triple immunosuppression one year after transplantation.