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Nocardia asteriods spinal osteomyelitis in an immunocompromised host from South India

The clinical presentation of nocardiosis is protean. Very few cases of spinal nocardiosis have been reported in the past. A 50 year old man, who was HIV seropositive presented with low grade fever and lower limb weakness. MRI study showed an extradural compression between T3 – T5 level with huge paraspinal soft tissue collection. The patient developed acute paraplegia on admission, and was treated with emergency surgical decompression. The pus sample collected during surgery yielded Nocardia asteroides. The patient was treated with combination of doxycycline and co-trimoxazole. Postoperatively, fever and chest symptoms resolved. However, there was no significant improvement in the neurological symptoms at the time of discharge from the hospital. High index of suspicion is therefore necessary to diagnose nocardial infections due to its varied presentations especially in an immunocompromised host. Early diagnosis and treatment can improve the outcome.