Rare Case of Disseminated Nocardiosis with Simultaneous Lung, Brain, and Spinal Cord Involvement in a Patient with Sarcoidosis

Nocardiosis is an uncommon opportunistic infection commonly affecting the lungs in immunocompromised individuals. We present an unusual case of disseminated nocardiosis involving the spinal cord and brain in a patient previously diagnosed with sarcoidosis and treated with glucocorticoids. We are presenting the case of a 46-year-old Caucasian male with sarcoidosis who develops pulmonary nocardiosis, with chest X-ray (CXR) revealing left lower lobe infiltrates diagnosed as community-acquired pneumonia usually caused by Nocardia, confirmed by excisional biopsy. A few days later, the disease progressed to the spinal cord, leading to an epidural abscess, and disseminated to the brain, leading to multiple ring-enhancing lesions confirmed by MR. Timely surgical intervention, such as abscess drainage, is crucial in the management of abscesses to prevent life-threatening complications and preserve neurological function. Clinicians should maintain a broad differential diagnosis when evaluating new pulmonary infiltrates in patients with sarcoidosis. Early CNS imaging should be considered in cases of severe pulmonary nocardiosis to prevent catastrophic complications.