Disseminated Nocardia paucivorans infection in an immunocompetent host

Nocardia paucivorans is a recently discovered species that has been shown to have a predilection for CNS involvement in cases of disseminated infection. We present a 50-year-old man with one year of weight loss admitted to the hospital with cough and confusion. Imaging revealed pulmonary and iliopsoas masses as well as innumerable ring-enhancing brain lesions. N. paucivorans was eventually identified in a subcarinal lymph node biopsy. The diagnosis was expedited by utilizing 16s rRNA gene sequencing on the biopsy tissue, resulting in species-level identification several weeks prior to culture positivity. He was treated with 12 months of parenteral and oral antibiotics, with resolution of pulmonary and brain lesions on repeat imaging.