disseminated nocardiosis in an immunocompromised child with unknown cause

disseminated nocardiosis (dn), is an infrequent and severe infection due to nocardia species and defined as infection in two or more discontinuous organs.  most infections occur in the immunocompromised host or in persons with underlying disease.  dn occurs rarely in children.  in this report, we describe an 11-year-old immune-compromised child with nocardiosis involving the lung, skin, brain and bone.  no predisposing factor nor any underlying disease was found to explain his immune deficiency.  diagnosis of nocardial infection is often cumbersome, resulting at times in wrong initial clinical diagnosis such as cancer and other bacterial infections (e.g. tuberculosis). therefore, it is important to consider nocardial infection in the differential diagnosis of children with combined brain and lung lesions.