Background: Nocardia brevicatena (N. brevicatena) is an uncommon cause of brain infections, frequently mistaken for intracranial tuberculosis, especially in patients with a tuberculosis (TB) history, leading to improper treatment. This case report outlines the symptoms, diagnosis, and treatment of a patient with multiple brain abscesses from N. brevicatena after laryngeal TB, highlighting the importance of next-generation sequencing (NGS) for accurate diagnosis.
Case presentation: This report details a 55-year-old man with a history of TB. Symptoms included dizziness, headache, and unsteady gait, with MRI revealing brain nodules and edema. He initially received anti-TB treatment, but it was ineffective. NGS identified N. brevicatena, and TB tests were negative. He was treated with anti-Nocardia drugs (compound sulfamethoxazole tablets (0.96 g, orally twice daily), amikacin sulfate injection (0.6 g, once daily), and imipenem-cilastatin sodium (0.5 g, every 6 hours)), leading to symptom improvement and MRI changes. Symptoms worsened when treatment was paused but resolved within a week of resuming therapy, following 45 days of treatment, the patient fulfilled the discharge criteria. After seven months, the patient fully recovered with normal MRI results.
Conclusion: Intracranial N. brevicatena infections are frequently misdiagnosed as TB in patients with a TB history. NGS of blood or cerebrospinal fluid accurately detects pathogens, and TB Xpert helps rule out TB. Both are crucial for targeted treatment and better patient outcomes.
Keywords: Nocardia; case report; intracranial infection.
© 2026 Li et al.