Cerebral nocardiosis in an immunocompetent patient: a diagnostic dilemma

Nocardia are aerobic, partially acid-fast, branching filamentous Gram-positive bacilli, found in soil and decaying vegetables which are acquired by direct inoculation or inhalation. Nocardiosis generally affects the immunocompromised patients and has become a significant opportunistic infection as the number of immunocompromised individuals has grown worldwide. Nocardial cerebral abscesses are rare and account for about 1–2% of all cerebral abscesses. The insidious manifestations and paucity of clinical and laboratory signs of bacterial inflammation often prompt the diagnosis of neoplasia. Early biopsy of the lesion to achieve specific identification, anti-microbial sensitivity profiles and institution of appropriate treatment are important for positive outcome of nocardial infections. This is a case of a nocardial brain abscess in an immunocompetent patient which has posed a diagnostic dilemma as the causative agent was only managed to be isolated after multiple biopsies.