PET imaging of cerebral and pulmonary Nocardia infection

We report the case of a 69-year-old man who was suspected to have lung cancer with a single metastasis to the brain. Initial workup for neurologic and pulmonary symptoms demonstrated a ring-enhancing lesion in his right frontal lobe on MRI all a lung mass on CT. An F-18 fluorodeoxyglucose positron emission tomography (FDG PET) scan demonstrated marked glucose hypermetabolism in the lung and brain lesions with maximal standard uptake values (SUV) in both lesions of approximately 11. Biopsy of the brain mass revealed an abscess and cultures grew Nocardia. He was treated for nocardiosis, and a repeat CT of the chest in 2 months and MRI of the brain in 5 months showed nearly complete resolution of the lesions. Currently, there are few reported cases of PET evaluation of brain abscesses, particularly Nocardia. We discuss the appearance of brain infections on FDG PET scans in immunocompetent and immunocompromised patients.