PMC9526183_01
Chest computed tomography demonstrating consolidation within the lateral right middle lobe, inferior right upper lobe and superior right lower lobe, associated with locules of gas and a confluent area of central cavitation.
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Given a lack of clinical improvement, computed tomography (CT) of the chest was completed and showed findings suspicious for necrotizing/cavitary pneumonia with a developing lung abscess (Fig. 1).
Bronchoalveolar lavage of the right middle lobe, demonstrating branching, filamentous Gram-positive bacilli, partially acid-fast staining on: A) Gram stain, B) modified Kinyoun stain, and C) Kinyoun stain, all at 1000 x magnification.
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Using a previously described broad-range 16S rDNA PCR method to sequence the first 400-600 bp of the 16S rDNA gene, the isolate was identified as Nocardia beijingensis complex (Fig. 2).
Head computed tomography demonstrating intra-axial rim-enhancing masses in the bilateral parietal lobes and right temporal lobe, associated with significant adjacent vasogenic edema without distant mass effect.
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To assess for possible disseminated nocardiosis, a CT scan of the head was performed despite a lack of focal neurologic symptoms (Fig. 3).
Chest computed tomography demonstrating resolution of opacification in the right middle lobe.
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Serial CT-chest and CT-head imaging throughout his 15-month course of TMP-SMX and doxycycline indicated improvement of the involved areas (Fig. 4, Fig. 5).