[The hidden infection: nocardiosis with multiple extra pulmonary foci]

Nocardiosis is a rare infection caused by Gram-positive aerobic bacteria of the genus Nocardia, mainly affecting immunocompromised patients. Its clinical presentation is variable and can mimic other infectious or neoplastic diseases, making it difficult to diagnose. We report the case of a 48-year-old patient recently diagnosed with HIV and a CD4 lymphocyte count of less than 50 cells/ uL, who consulted for prolonged fever without apparent focus. Despite initial empirical antibiotic treatment, fever persisted. Computed tomography showed multiple extrapulmonary abscesses in unusual sites: iliac muscle, prescapular region, adrenal gland and cerebellar hemisphere. The definitive diagnosis was established by culture of the material obtained by percutaneous drainage, identifying Nocardia spp. The patient received targeted treatment with imipenem, ceftriaxone and trimethoprimsulfamethoxazole, achieving a favorable clinical course. This case highlights the importance of considering nocardiosis in the differential diagnosis of prolonged fever with multiple deep lesions in immunocompromised patients.