{
  "abstract": "Background Nocardiosis is an opportunistic bacterial infection that typically affects immunocompromised hosts, however one third of cases are seen in immunocompetent patients. Disseminated disease is rarely seen outside of immunocompromised states. Nocardia paucivorans is an uncommon species amongst reported cases in Australia. The present case details the diagnostic challenges of disseminated N.paucivorans in an immunocompetent patient, given nonspecific imaging features and the prolonged culture time required.Case A 50-year-old male presented with a one-week history of severe lower back pain radiating to lower limbs, incomplete bladder emptying, and three months of non-productive cough. There was no history of malignancy, transplant, or steroid use. MRI brain and spine revealed an enhancing intramedullary mass at T12-L1 with florid vasogenic oedema, and two ring enhancing cortical lesions. CT chest revealed widespread ground-glass change and right upper lobe consolidation. In the presence of rapidly progressing weakness and whilst awaiting results of investigations including pulmonary biopsy, high dose intravenous steroids were commenced for potential sarcoid, alongside broad-spectrum antimicrobials. Lower limb weakness progressed to flaccid paralysis.The biopsy returned mixed inflammation and fibrosis without granulomatous inflammation. Late growth from a single sample revealed a possible aerobic actinomycete, moderately Ziehl-Neelsen positive. Empirical treatment for severe nocardiosis was commenced with meropenem, linezolid and trimethoprim/sulfamethoxazole. Nocardia paucivorans was later cultured. Sensitivity directed combination empiric therapy continued and a 12-month antimicrobial course was advised. Immunodeficiency testing was unremarkable. No neurological recovery occurred.Conclusion Disseminated nocardiosis can occur in immunocompetent patients. Despite susceptibility directed antimicrobial therapy, prognosis can be poor.",
  "authors": [
    {
      "affiliations": [
        "John Hunter Hospital, Newcastle, NSW, Australia"
      ],
      "name": "Karly Potts"
    },
    {
      "affiliations": [
        "Tamworth Hospital, Tamworth, NSW, Australia"
      ],
      "name": "Bridget Hughes"
    }
  ],
  "title": "3536 An unexpected cause for myelitis: disseminated nocardiosis in an immunocompetent patient",
  "uid": "2a857888-aeea-5e9a-af14-a0c520f70217"
}