CTICasesPulmonary Nocardiosis with CNS Involvement
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Imaging findings
Chest radiograph showed multiple small nodules and several large masses. CT angiogram revealed areas of necrosis within these pulmonary masses, consistent with a necrotizing infection. Brain MRI demonstrated multiple small, rim-enhancing lesions, which were presumed to be metastatic nocardiosis. A craniotomy defect from a prior astrocytoma resection was also noted.
Key takeaways
Pulmonary nocardiosis can present as necrotizing pulmonary masses and nodules, often with dissemination to the central nervous system (CNS), leading to brain abscesses. High-dose steroid use, common in patients with brain tumors (e.g., astrocytoma) to manage swelling, is a significant risk factor for opportunistic infections like Nocardia. CNS involvement necessitates a prolonged course of antibiotic treatment. The patient, despite the severity, was reportedly doing well.
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