A Rare Case of Disseminated Nocardia transvalensis in an Immunocompetent Host

<b>Background</b>: <i>Nocardia</i> are a group of bacteria known to cause pulmonary, cutaneous, neurologic, or disseminated diseases, usually in immunocompromised hosts. Within the <i>Nocardia</i> family is <i>Nocardia transvalensis</i>, a rarely encountered and underreported organism in the clinical literature. <b>Case</b>: Here, we report the case of an immunocompetent patient presenting with lumbar pain diagnosed and treated for disseminated <i>Nocardia transvalensis</i> infection. Our patient underwent magnetic resonance imaging (MRI), demonstrating possible abscess and subtle osteomyelitis of the L3-L4 facet joint and transverse process; a subsequent biopsy and culture resulted in <i>Nocardia transvalensis</i>. Further imaging with a computed tomography (CT) scan of the head revealed a 9 mm enhancing supratentorial lesion. The patient was treated with empiric antibiotics, but this was narrowed to levofloxacin, linezolid, and trimethoprim-sulfamethoxazole after antibiotic sensitivities cropped up. <b>Conclusions</b>: Within this case, we extensively discuss the clinical pathogenesis of <i>Nocardia transvalensis</i> in an unusual host, the diagnostic approach to confirming active <i>Nocardia</i> infection, and the susceptibility patterns in a relatively unstudied organism.