To explore the diagnostic features of patients with multiple abscesses caused by Nocardia.

The clinical data of one patient infected with Nocardia in Neurology Department of Affiliated Hospital of Jining Medical University on December 26, 2017 was retrospectively studied and the relevant literatures were reviewed.

The patient was mainly presented with cough, fever, paroxysmal limb convulsion accompanied by headache, physical examination showed collapsed abscess on the chest wall and the pus flowed out. The number of cerebrospinal fluid cells was 8×10⁶/L, protein level in the cerebrospinal fluid was 1.448 g/L, and none of bacteria, fungi and acid-fast bacilli was observed in the general culture. The chest CT showed multiple cavities and interstitial changes in both lungs. The brain magnetic resonance imaging (MRI) showed abnormal signals with multiple ringlike walls and surrounding edema, of which the ringlike walls were enhanced. After a culture of chest wall pus for 3 days, yellow-white colonies were observed and mycobacteria in line with the characteristics of Nocardia were identified by the weak acid-fast staining and Gram-staining. After the treatment of sodium sulfadiazine and amoxicillin-clavulanate, the patient recovered with clinical improvement and the brain MRI showed significantly absorbed frontal abscess.

The patients with multiple abscesses caused by Nocardia have prolonged disease progression and lack specificity in clinical and imaging findings. The patients with immunosuppressive status and poor response to general antibiotic treatment should be considered as the Nocardia infection and the culture of Nocardia should be performed as soon as possible.