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Unusual manifestation in a case of nocardial meningitis.

A case of subacute progressive painful external ophthalmoplegia of the right eye in a 55-year-old woman is reported. CT scan of the brain, paranasal sinuses and orbits revealed normal findings. Tolosa-Hunt syndrome was diagnosed and high dose prednisolone was given. The patient later developed fever, confusion and stiffneck. Lumbar puncture showed grossly purulent CSF with Gram-positive coccobacilli and rod organism. CSF culture grew Nocardia spp. The patient made a complete recovery with trimethoprim-sulfamethoxazole treatment.