Nocardia cyriacigeorgica threatening an immunocompetent host; a rare case of paramediastinal abscess

Abstract

We describe a rare case of anterior paramediastnial abscess due to Nocardia cyriacigeorgica in an immunocompetent patient without pre-existing lung disease. High suspicious should be taken in those patients that failed to improve after first course of antibiotic therapy. Similarly, when suspected, isolation is crucial because of the variation in antibiotic susceptibilities among Nocardia spp. in order to provide adequate therapy to reduce associated comorbidities and mortality rate.

Figure 1:

Chest CT scan shows multifocal bilateral pulmonary consolidations and right anterior inferior paramediastinal abscess measuring ~7 cm LG × 5.8 cm AP × 6.7 cm TV (red arrow).

Figure 2:

Chest CT scan shows interval resolution of paramediatinal abscess (red arrow) after percutaneous drainage and resolution of lung infiltrates after 2 weeks.