Discussion
Nocardia asteroides in an immunocompromised patient most often produces
Answer: B
Correct answer: Pulmonary nocardiosis, which may disseminate to the brain
Nocardia is an aerobic soil organism acquired by inhalation, and in a patient with impaired cell-mediated immunity - a transplant recipient, someone on long-term steroids, or a patient with lymphoma - it produces a subacute pneumonia with cavitation that resembles tuberculosis. Haematogenous spread to the brain, giving single or multiple abscesses, occurs in up to a third of cases and is what makes the diagnosis urgent. Cervicofacial actinomycosis is a disease of Actinomyces, not Nocardia, and the other two options belong to quite different organisms.
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