Disseminated Nocardia infection in a patient with systemic lupus erythematosis: A case report

28 year old female who was under treatment for systemic lupus erythematosus with oral prednisolone for 4 months presented with history of fever with chills, productive sputum, pleuritic chest pain, exertional breathlessness, anorexia and was found to have signs of pneumonia clinically on the right side. She also gave history of gradual painful diminution of vision in her left eye and two episodes of generalized tonic clonic seizures just prior to admission. Despite empirical treatment with antibiotics, her condition gradually deteriorated. A computer tomography – thorax (HRCT), showed linear and nodular opacities in right middle lobe segments and right medial basal segment along with homogenous opacity with multiple cavitations noted in the lower lobe of right lung with air bronchogram. MRI- brain  showed multiple conglomerate foci of ring enhancing lesions with moderate surrounding edema seen in bilateral cerebral hemispheres, irregular thickening of choroid seen in left eye with hyperintense vitreous cavity showing blooming. CSF did not show any abnormality. Nocardia farcinica was isolated from the vitreous. Diagnosis of Disseminated nocardiosis involving lungs, brain and left eye was made.&nbsp