A case of disseminated nocardia infection with initial symptoms manifesting as cognitive impairment: Case report and literature review.

RATIONALE: Nocardia infections, although rare, pose significant challenges in diagnosis and treatment, especially when involving the central nervous system (CNS). Mortality rates in such cases can be high, highlighting the need for early recognition and tailored antimicrobial therapy.

PATIENT CONCERNS: A 58-year-old male with a history of chronic obstructive pulmonary disease, antineutrophil cytoplasmic antibody-associated glomerulonephritis, and steroid-induced diabetes mellitus presented with disorganized speech, fever, cough, dyspnea, and psychiatric symptoms.

DIAGNOSES: The patient was diagnosed with severe pneumonia, left pneumothorax, bilateral pulmonary bullae, and CNS involvement. Next-generation sequencing (NGS) identified Nocardia farcinica as the causative agent.

INTERVENTIONS: Initial treatment with ceftriaxone was ineffective. Upon identification of N. farcinica via NGS, the patient was started on a tailored antimicrobial regimen consisting of sulfamethoxazole, linezolid, and meropenem.

OUTCOMES: Despite initial clinical improvement, the patient was discharged early due to financial constraints. Unfortunately, he later succumbed to the infection.

LESSONS: This case underscores the difficulty of diagnosing Nocardia infections, particularly when they involve the CNS. The use of advanced diagnostic tools such as NGS, along with early and appropriate antimicrobial therapy, is crucial for improving patient outcomes. Financial and healthcare access challenges may impact the success of treatment, emphasizing the importance of comprehensive follow-up and patient support.