• Xiayahu Li, Weiguo Zhou, Kai Zhao, and Yaolin Li.
• Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, China.
• Medicine (Baltimore). 2024 Dec 6; 103 (49): e39535e39535.

RationaleNocardia infections, although rare, pose significant challenges in diagnosis and treatment, especially when involving the central nervous system (CNS). Mortality rates in such cases can be high, highlighting the need for early recognition and tailored antimicrobial therapy.Patient ConcernsA 58-year-old male with a history of chronic obstructive pulmonary disease, antineutrophil cytoplasmic antibody-associated glomerulonephritis, and steroid-induced diabetes mellitus presented with disorganized speech, fever, cough, dyspnea, and psychiatric symptoms.DiagnosesThe patient was diagnosed with severe pneumonia, left pneumothorax, bilateral pulmonary bullae, and CNS involvement. Next-generation sequencing (NGS) identified Nocardia farcinica as the causative agent.InterventionsInitial treatment with ceftriaxone was ineffective. Upon identification of N. farcinica via NGS, the patient was started on a tailored antimicrobial regimen consisting of sulfamethoxazole, linezolid, and meropenem.OutcomesDespite initial clinical improvement, the patient was discharged early due to financial constraints. Unfortunately, he later succumbed to the infection.LessonsThis case underscores the difficulty of diagnosing Nocardia infections, particularly when they involve the CNS. The use of advanced diagnostic tools such as NGS, along with early and appropriate antimicrobial therapy, is crucial for improving patient outcomes. Financial and healthcare access challenges may impact the success of treatment, emphasizing the importance of comprehensive follow-up and patient support.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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