Disseminated nocardiosis

摘要

A 64-year-old smoker with a cough was found to have a pulmonary opacity on computed tomography (CT) scan of the chest (Fig. 1). He was on treatment with thalidomide and intermittent dexamethasone for multiple myeloma and was HIV negative. Needle biopsy of the chest lesion showed Nocardia'asteroides. Magnetic resonance imaging scan of the brain carried out to investigate an episode of focal seizures showed a frontal lobe lesion, presumed to be a Nocardia brain abscess (Pig. 2). Initial treatment with i.v. cotrimoxazole, ami-kacin, meropenem and linezolid was followed by monotherapy with oral cotrimoxazole. The lung lesion regressed but the brain abscess increased in size and was surgically excised, with no recurrence on subsequent imaging.