Disseminated brain Nocardia abscess with bronchial and esophageal fistulas

Disseminated nocardiosis is a rare but life-threatening infection, with limited documented cases. Moreover, there have been no reports of Nocardia mediastinal abscess leading to bronchial or esophageal fistulae. We present a 62-year-old immunocompetent male with cerebellar and mediastinal abscesses caused by Nocardia beijingensis, complicated by both bronchial-mediastinal and esophageal fistulas. He received treatment including surgical intervention, endoscopic procedures, and antibiotic therapy. This case highlights the critical role of multidisciplinary collaboration in diagnosing and managing disseminated nocardiosis, particularly when rare complications arise. Early molecular diagnostics (next-generation sequencing, NGS) and individualized treatment adjustments were pivotal.