A Case Report of Multiple Cerebral Abscesses Due to Nocardia in the Absence of Pulmonary Disease

A 64-year-old woman with Waldenstrom macroglobulinemia presented with seizures and was found to have multifocal Nocardia farcinica cerebral abscesses. Nocardia species are an uncommon cause of cerebral abscesses that can occur spontaneously via inoculation from the environment, especially in immunocompromised patients, and usually appear with concomitant pulmonary disease. Nocardia infections generally portend a worse prognosis than other organisms causing the same clinical syndrome because they are difficult to treat. Treatment of cerebral Nocardia consists of combination therapy upfront with a sulfonamide and another agent, with long treatment regimens of up to a year.