Observations:

A 70 years- old farmer who presented with three months’ history of fever with chills, productive sputum, pleuritic chest pain, exertional breathlessness, anorexia and three days history of altered sensorium was found to have signs of pleural effusion clinically on the right side. Aspiration revealed frank pus which was drained by an intercostal tube. Subsequently the patient developed multiple abscesses in the right costal area which were drained surgically. Gram staining of the purulent material revealed Gram positive and acid fast bacilli which had branching and fragmented morphology, suggestive of Nocardia. Thorax CT revealed a resolving consolidation with pleural effusion on the right side. Cranial CT with contrast revealed multiple ring enhancing lesions with vasogenic edema in the right fronto-parietal and left occipital area. CSF did not show any abnormality. A diagnosis of disseminated Nocardiosis was made. Patient was started a treatment with Trimethoprim-Sulphmethoxazole and is on regular follow up. The case is highlighted because of the rarity of the disease and the patient in question did not have an underlying immune compromise or any other systemic disease.

Keywords: Nocardia, actinomycetes, immunosuppression suppurative disease, trimehoprim-sulphmethoxazole