PMC8461374_01
(A) pustules on abdomen and little finger of right hand (B) Chest Xray, (C) Gram Stain showing Nocardia.
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There were multiple skin pustules of different ages scattered over the upper limbs, lower limbs, back and abdomen (Fig. 1-A). Chest X-ray showed consolidation with cavitation and pleural effusion in the right lower zone (Fig. 1-B). All cultures from sputum, broncho-alveolar lavage (BAL), skin pustules pus showed on gram stain branching, fine, delicate filaments with fragmentation, beaded gram-positive bacilli (Fig. 1-C).
(A) CT showing pneumonia with lung abscess and pneumothorax (B) CT showing Septic Emboli in Lung (C) CT showing lesions in Liver and Spleen.
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A computed tomography (CT) scan of the chest showed necrotizing pneumonia with lung abscess and pneumothorax in the left lung (Fig. 2-A). Few septic emboli also were visualized in left lung (Fig. 2-B). The images also revealed multiple collections in the liver spleen and kidneys (Fig. 2-C).
(A) MRI showing abscesses involving the cerebellar vermis and the left para-median cerebellar hemisphere (B) right frontal vascular malformation of 6 mm diameter with a feeding vessel from the distal portion of the anterior cerebral artery and draining into cortical vein (C) Chest X ray after 6 months of treatment.
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These abscesses showed central diffusion restriction, peripheral enhancement, and internal enhancing septations (Fig. 3-A). A repeat imaging revealed intracranial hemorrhage and right frontal vascular malformation of 6 mm of diameter with a feeding vessel from the distal portion of the anterior cerebral artery and draining into a cortical vein (Fig. 3-B). A CT of the brain done after 6 months of treatment showed complete resolution of the brain abscesses and a repeat chest Xray (Fig. 3-C) showed clearance of the initial changes.