Brain Nocardiosis Defined by 18F-Fluorocholine PET/CT

Nocardia infection (nocardiosis) is usually acquired by inhalation; so pulmonary nocardiosis is the most common clinical presentation. Extrapulmonary localization occurs through hematogenous dissemination or contiguous spread. Nocardia can involve the central nervous system in a very reduced number of patients, mainly in immunocompromised. We present a case of a 56-year-old woman with a history of aggressive systemic mastocytosis, treated with chemotherapy 1 year ago. Patient reported intense headache, disorientation, and blurry vision without other symptoms being diagnosed with a rare brain nocardiosis by Nocardia cerradoensis. Neither bacteremia nor pulmonary involvement was detected. Brain PET/CT illustrated F-18-fluorocholine avidity on brain abscesses.

Automated summary

Nocardia infection is commonly acquired through inhalation, leading to pulmonary nocardiosis as the most common clinical presentation. In rare cases, Nocardia can invade the central nervous system, especially in immunocompromised patients. We present a case of rare brain nocardiosis caused by Nocardia cerradoensis in a 56-year-old woman with a history of aggressive systemic mastocytosis, without bacteremia or pulmonary involvement. Brain PET/CT showed F-18-fluorocholine avidity on brain abscesses.