When you least expect it—a case of disseminated nocardiosis in an immunocompetent patient

Nocardiosis is a rare disease caused by Nocardia spp. that can mostly be found in immunocompromised patients, such as those affected by HIV, diabetes, tumors, or those taking long-term corticosteroids or other immunosuppressants. However, up to one-third of patients with nocardiosis may be immunocompetent. The most common presentation of nocardiosis consists of pulmonary nodules or consolidation, sometimes with cavitation, detected on chest X-ray (CXR) or computed tomography (CT) scan, along with brain lesions and soft-tissue abscesses. Patients usually present with non-specific symptoms, such as fever, dyspnea, productive cough, fatigue, and chest pleuritic pain; thus, diagnosis may be challenging. Because of that, tumors and tuberculosis should also be included in the differential diagnosis. In this article, we will discuss the case of an immunocompetent patient affected by disseminated nocardiosis, which initially went undetected.