BMJ Case Reports 2016; doi:10.1136/bcr-2016-215649

Unusual presentation of disseminated Nocardia abscessus infection in a patient with AIDS

  1. Onyema Ogbuagu2
  1. 1Yale-New Haven Hospital, New Haven, Connecticut, USA
  2. 2Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Onyema Ogbuagu, onyema.ogbuagu{at}
  • Accepted 5 July 2016
  • Published 20 July 2016


A 40-year-old man with AIDS presented with symptoms of a chronic cough, subacute headache, generalised weakness with falls, urinary and faecal incontinence, and acute onset subcutaneous nodules. A chest CT scan showed multiple cavitary and nodular pulmonary infiltrates. MRI of his brain and spinal cord revealed innumerable ring-enhancing lesions. Pathological examination of the purulent material obtained from his subcutaneous lesions, as well as transbronchial tissue specimens obtained by biopsy, revealed beaded and branching Gram-positive rods, subsequently identified by 16S RNA sequencing to be Nocardia abscessus species. We observed an excellent therapeutic response to a combination antimicrobial therapy with resolution of the subcutaneous, pulmonary and central nervous system (CNS) lesions. Infections caused by N. abscessus are rare and typically occur in immunocompromised patients. In this article, we will review the presentation, diagnosis and treatment of N. abscessus infection.

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