{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:16:41Z","timestamp":1792891001871,"version":"4.5.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Central nervous system (CNS) nocardiosis is a rare but lethal opportunistic infection, presenting a formidable diagnostic and therapeutic challenge, especially in immunocompromised populations. The most common presentation is a cerebral abscess.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report the case of a 53-year-old male with a history of relapsed and refractory multiple myeloma who presented with an acute change in mental status and ataxia. Initial clinical suspicion centered on a posterior circulation ischemic event. However, magnetic resonance imaging (MRI) revealed a large, rim-enhancing cerebellar mass with associated obstructive hydrocephalus. The patient underwent surgical excision of the lesion, and subsequent microbiological culture confirmed an abscess caused by a <jats:italic>Nocardia<\/jats:italic> species. He was treated with a prolonged course of targeted antimicrobial therapy, including intravenous imipenem, followed by oral linezolid and trimethoprim-sulfamethoxazole. At the 3-month outpatient follow-up after discharge, the patient was found to have thrombocytopenia, attributed to the side effects of oral trimethoprim-sulfamethoxazole. Treatment was subsequently maintained with oral linezolid 600\u202fmg for 1\u202fyear. Despite improvement of the abscesses, the patient ultimately succumbed to the progression of his long-standing multiple myeloma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case underscores the importance of including uncommon opportunistic pathogens like <jats:italic>Nocardia<\/jats:italic> in the differential diagnosis of CNS lesions in immunocompromised patients. A definitive diagnosis via microbiological analysis of tissue specimens is imperative to guide appropriate antimicrobial therapy and achieve a favourable clinical outcome.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1687102","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:26:20Z","timestamp":1759123580000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Nocardia infection: a rare case report of a cerebellar mass"],"prefix":"10.3389","volume":"12","author":[{"given":"Izzuddin","family":"Azaharuddin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Nizam","family":"Mokhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan Hun","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Imree","family":"Azmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah Hanim","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yik Peng","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Affiza","family":"Zainudin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.3390\/microorganisms10061120","article-title":"Nocardia infections in the immunocompromised host: a case series and literature review","volume":"10","author":"Palomba","year":"2022","journal-title":"Microorganisms"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1159\/000508717","article-title":"Nocardiosis: a neglected disease","volume":"29","author":"Duggal","year":"2020","journal-title":"Med Princ Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1008280","DOI":"10.1371\/journal.ppat.1008280","article-title":"Pathogenic Nocardia: a diverse genus of emerging pathogens or just poorly recognized?","volume":"16","author":"Mehta","year":"2020","journal-title":"PLoS Pathog"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4601","DOI":"10.2147\/IDR.S249761","article-title":"Invasive nocardiosis: disease presentation, diagnosis and treatment\u2014old questions, new answers?","volume":"13","author":"Lafont","year":"2020","journal-title":"Infect Drug Resist"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1186\/s12890-024-03217-0","article-title":"Clinical features and outcomes of persons with cystic fibrosis and Nocardia isolation: a systematic review","volume":"24","author":"Terlizzi","year":"2024","journal-title":"BMC Pulm Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1159\/000525509","article-title":"Clinical characteristics and treatment outcome of central nervous system nocardiosis: a systematic review of reported cases","volume":"31","author":"Meena","year":"2022","journal-title":"Med Princ Pract"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1080\/20009666.2021.1877399","article-title":"Brain metastasis or nocardiosis? A case report of central nervous system nocardiosis with a review of the literature","volume":"11","author":"Sun","year":"2021","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s40001-021-00562-2","article-title":"A case report of brain abscess caused by Nocardia farcinica","volume":"26","author":"Song","year":"2021","journal-title":"Eur J Med Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1080\/14787210.2024.2448723","article-title":"Update on actinomycetoma treatment: linezolid in the treatment of actinomycetomas due to Nocardia spp and Actinomadura madurae resistant to conventional treatments","volume":"23","author":"Bonifaz","year":"2025","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e937952","DOI":"10.12659\/AJCR.937952","article-title":"Brain abscesses caused by Nocardia farcinica in a 44-year old woman 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