Nocardia Brain Abscess Mimicking Metastases in an Immunocompromised Patient

The differential for ring-enhancing lesions of the brain is extensive, with patient characteristics, particularly immunologic status, crucial to the clinical plan. In immunocompromised patients with a single ring-enhancing lesion, aspergillosis, toxoplasmosis, and nocardial infections are considered. In the case of multiple ring-enhancing lesions, metastases often supersede opportunistic infections on the differential. We present an unusual case of multiple nocardial brain abscesses mimicking metastases in an immunocompromised patient with a history of narcolepsy.