Multiple rim-enhancing brain lesions and pulmonary cavitary nodules as the presentation of Nocardia cyriacigeorgica in a patient with non–small cell lung cancer

• Published in: Proceedings - Baylor University. Medical Center Vol. 35; no. 4; pp. 555 - 556
• Main Authors: Bejcek, Alexis, Owens, Justin, Marella, Aditi, George, Aneesh
• Format: Journal Article
• Language: English
• Published: Dallas Taylor & Francis Ltd 04.07.2022; Taylor & Francis
• Subjects: Case Report; Case Studies; Gram-positive bacteria; Lung cancer; Nervous system
• ISSN: 0899-8280; 1525-3252
• DOI: 10.1080/08998280.2022.2058831

Nocardiosis is caused by various strains of the genus Nocardia, a gram-positive, acid-fast bacillus found in organic matter. Disseminated nocardiosis with central nervous system involvement is a rare infection that is most commonly seen in immunocompromised patients. We present a case of a 67-year-old veteran with stage IV adenocarcinoma of the lung undergoing chemotherapy who presented with new cavitary pulmonary lesions. Three weeks into his hospitalization, a sputum culture with acid-fast staining returned positive for Nocardia cyriacigeorgica. A subsequent computed tomography scan of the head demonstrated numerous rim-enhancing lesions presumed to be due to disseminated nocardiosis with central nervous system involvement. Disseminated nocardiosis has a high mortality rate, making prompt detection and treatment paramount for these patients. Our case highlights the importance of considering central nervous system involvement in the evaluation of a patient with nocardiosis.