A case of secondary pulmonary infection in a patient with acute exacerbation of chronic obstructive pulmonary disease was admitted. The patient was initially giren piperacillin-tazobactam combined with levofloxacin for anti-infective treatment before the pathogen was identified. lafer, the HRZE anti-tuberculosis regimen was added, but the patient continued to experience high fever, yellow purulent sputum, and dyspnea. Subsequent, bronchoalveolar lavage fluid pathogen metagenomic sequencing revealed Nocardia terpenica. Clinical pharmacists, based on the patient's condition changes and in accordance with relevant guidelines and literature, suggested using various antimicrobial agents, including compound sulfamethoxazole tablets, linezolid glucose injection, amikacin injection combined with imipenem-cilastatin, to manage the patient's intolerance to sulfonamides and the bone marrow suppression induced by linezolid and to provide medication suggestions. The clinician adopted all the suggestions. Through the collaborative efforts of physicians and clinical pharmacists, the patient's condition improved, allowing for discharge with medication. Post-discharge, medication education and follow-up were conducted, leading to successful recovery. In this case, the clinical pharmacist reviewed domestic and international literature on Nocardia terpenica and the characteristics of antimicrobial drugs, and utilized their expertise to assist clinicians in treating rare infection cases, realizing their professional value.

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