eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2016-08-12 4 7 251 254 10.12691/ajmcr-4-7-10 AJMCR20164710 article Osamuyimen Igbinosa Uyi80@yahoo.com 1 Owen Igbinosa 2 Krishna Dass 2 Glenn Wortmann 2 Section of Infectious Diseases, MedStar Washington Hospital Center, Washington DC USA Department of medicine, Obafemi Awolowo University Teachings Hospitals Complex, Ile-Ife, Nigeria Patients with T-cell defects are at the highest risk for nocardiosis, a potentially life-threatening infection caused by several species of the genus, Nocardia. We report a case of disseminated Nocardia arthritidis in a patient who had no recognizable risk factors for immunodeficiency. A 43-year-old woman was noted to have a left upper lobe cavitary lesion on an outpatient computerized tomography (CT) scan that was performed for evaluation of pelvic congestion syndrome. She subsequently had an image-guided biopsy of the lesion, but the results were still pending when she presented at the emergency department with a transient episode of aphasia. A CT scan of the patient's head revealed hypodensities in the right frontoparietal and left frontal lobes. A modified acid-fast stain on the lung biopsy specimen demonstrated variable, branching, filamentous bacteria with morphology consistent with Nocardia species. Matrix-Assisted Laser Desorption / Ionization - Time-of-Flight (MALDI-TOF) Mass Spectrometry at a reference laboratory later identified the bacteria as Nocardia arthritidis. This case highlights that disseminated nocardiosis can occur in an apparently healthy population. A more detailed immunologic evaluation that include screening for chronic granulomatous disease, anticytokine autoantibody deficiency and interleukin-12-gamma interferon pathway deficiency may further assist in the diagnosis of patients' underlying diseases. http://pubs.sciepub.com/ajmcr/4/7/10/ajmcr-4-7-10.pdf Norcadiosis Norcadia arthritidis Immunocompromised