Disseminated Nocardia transvalensis infection with osteomyelitis and multiple brain abscesses

A case of Nocardia transvalensis osteomyelitis and cerebral abscesses is described. To the authors' knowledge, the patient described here represents the first reported case of primary N. transvalensis leg abscess with contiguous osteomyelitis of the femur and secondary brain abscesses. The literature on nocardial osteomyelitis and cerebral nocardiosis is reviewed, and treatment of both conditions is discussed. The interactions between the immune system and nocardial organisms are described, as well as the host defense defects in diabetic patients as they relate to pathogenicity of the bacteria. Finally, the patient's paradoxical therapeutic response of resolving brain abscesses with concomitant unresolving osteomyelitis is discussed, as well as its implications for managing similar cases in the future.