Disseminated nocardiosis - a case report

Nocardiosis, caused by various species of Nocardia, poses diagnostic and therapeutic challenges due to its diverse clinical presentations that often mimic other infections and malignancies. We present the case of a 72-year-old woman with a history of autoimmune hepatitis and diabetes mellitus (DM) who initially presented with fever, headaches, and confusion. Extensive investigations revealed an ischemic lesion in the central nervous system (CNS) attributed to vasculitis. Two months later, returned with literal paraphasia, ocular symptoms (red eye and retro-orbital pain), and fever. Despite negative blood cultures, Nocardia cyriacigeorgica was isolated from vitreous humour and lung tissue, confirming the diagnosis of disseminated nocardiosis. Treatment included trimethoprim/sulfamethoxazole (TMP/SMX), Meropenem, and Linezolid, led to significant improvement. This case underscores the diagnostic complexity of Nocardiosis, emphasizing the need for early and precise diagnosis, multidisciplinary care, and prolonged treatment in severe cases. Further research is required to optimize therapeutic protocols, particularly in CNS-involved nocardiosis.