PMC5503885_01
CT chest on hospital day 4, showing multiple pulmonary nodules and tree-in-bud opacities.
gr1.jpg
PMC5503885_01_gr1.jpg
fig0005
His initial CT scan of the chest to evaluate his fevers showed multiple pulmonary nodules, which were attributed to progression of chronic GVHD (Fig. 1: CT chest on hospital day 4, showing multiple pulmonary nodules and tree-in-bud opacities).
CT abdomen on hospital day 4, with vague 1 cm lesion in pancreatic body.
gr2.jpg
PMC5503885_01_gr2.jpg
fig0010
He also had a CT of the abdomen that showed a nebulous, hypoattenuating 1 cm lesion in the pancreatic body (Fig. 2: CT abdomen on hospital day 4, with vague 1 cm lesion in pancreatic body).
CT abdomen on hospital day 20, showing worsening pancreatic collection.
gr3.jpg
PMC5503885_01_gr3.jpg
fig0015
Repeat CT of the abdomen showed a new pancreatic tail fluid collection measuring 6 cm x 4.5 cm x 4.1 cm (Fig. 3: CT abdomen on hospital day 20, showing worsening pancreatic collection).
CT abdomen on hospital day 25, showing worsening pancreatic collection and new caudate lobe collection.
gr4.jpg
PMC5503885_01_gr4.jpg
fig0020
In addition, there was a new intraperitoneal loculated collection near the liver (Fig. 4: CT abdomen on hospital day 25, showing worsening pancreatic collection and new caudate lobe collection).
MRI brain on hospital day 36, with punctate enhancing lesions and one notable ring-enhancing lesion (T1 post contrast).
gr5.jpg
PMC5503885_01_gr5.jpg
fig0025
Given the propensity for nocardiosis to affect the CNS, the patient had MRI scans of the brain and complete spine, which showed multiple microabscesses affecting the brain and cervicothoracic spine (Fig. 5: MRI brain on hospital day 36, with punctate enhancing lesions and one notable ring-enhancing lesion (T1 post contrast).