Nocardiosis Unmasked: Therapeutic Challenges of Multiple Abscesses in an Immunocompromised Patient

Nocardiosis has a predilection for affecting the lungs or occurs as a disseminated disease. Cerebral involvement resulting in multiple brain abscesses is rarely reported in 2% of cases. A 30-year-old woman diagnosed with immunocompromised state six months back presented with headache, multiple episodes of seizures, and progressive right hemiparesis for the past three months. She was initially treated with antibiotics, but in view of non-improvement, an early burr-hole aspiration of the abscess resulted in the correct diagnosis. She was then subsequently treated with antimicrobial therapy and surgical excision of the abscess, resulting in significant improvement. Follow-up at four-month duration showed significant improvement with complete resolution of all clinical features. Patients with multiple cerebral nocardial abscesses may require combined treatment with antimicrobial therapy and surgical excision to improve the mortality and prognosis. An early burr-hole-guided aspiration results in faster etiological diagnosis and prompt targeted approach.