Disseminated nocardiosis of the central nervous system (CNS) has been rarely reported, especially in the immunocompetent patient. We report a case of cerebral and cervical intradural extramedullary nocardiosis likely to have been the result of disseminated spread from a pulmonary infective focus. Attempts at tissue biopsy and culture of the initial cerebral and pulmonary lesions both failed to yield the diagnosis. Interval development of a symptomatic intradural extramedullary cervical lesion

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... sulted in open biopsy and an eventual diagnosis of nocardiosis was made. We highlight the diagnostic dilemma and rarity of spinal nocardial dissemination in an immunocompetent individual. LEARNING POINTS • Disseminated nocardiosis can occur in immunocompetent patents. • Systemic manifestations of sepsis suggested an infective aetiology. • When disseminated lesions are found, tissue diagnosis Is vital in directing management; in this case, biopsies were taken from both thoracic and spinal lesions.