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BRIEF RESEARCH REPORT article

Front. Med.

Sec. Infectious Diseases: Pathogenesis and Therapy

Chronic meningoencephalomyelitis caused by Nocardia nova infection: a case report and literature review

Provisionally accepted
Shao LiShao Li1Qianqian TianQianqian Tian2Xixi YangXixi Yang3Mengyao ZhangMengyao Zhang4Menghan ZhengMenghan Zheng4Dawei LiDawei Li4Zhihui DuanZhihui Duan1Yan LiYan Li1Zhandong QiuZhandong Qiu3*Zheng LiuZheng Liu4*
  • 1Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
  • 2Affiliated Hospital of Shandong Second Medical University, Weifang, China
  • 3Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 4Xuanwu Hospital Capital Medical University Department of Neurology, Beijing, China

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A 25-year-old female zookeeper presented with 3-month history of sore throat and headache, 2-month intermittent fever, and 1-month dizziness. Neurological examination revealed bilateral nystagmus, left-sided sensory loss, ataxia, and subtle meningeal signs. Brain and cervical spinal cord MRI showed multiple enhancing lesions with central vein signs. Cerebrospinal fluid (CSF) analysis demonstrated elevated pressure (240 mmH2O) and leukocytosis (140×10⁶/L). Serum MOG-IgG was positive (1:32), while CSF metagenomic next-generation sequencing (mNGS) confirmed Nocardia nova infection. Initial treatment with trimethoprim-sulfamethoxazole (TMP-SMX), amikacin, and imipenem-cilastatin was followed by regimen adjustment to TMP-SMX plus minocycline at 6 weeks. One-month post-therapy, repeat CSF showed normalized pressure, reduced leukocytes, negative mNGS, and MRI evidence of lesion regression. Complete symptom resolution occurred two months after treatment initiation. This case exemplifies a rare presentation of N. nova-induced meningoencephalomyelitis with craniospinal involvement in an immunocompetent individual.

Keywords: Nocardia, nova, Infection, chronic, Meningoencephalomyelitis, targeted, Metagenomic, Next-generation sequencing

Received: 07 Aug 2025; Accepted: 31 Oct 2025.

Copyright: © 2025 Li, Tian, Yang, Zhang, Zheng, Li, Duan, Li, Qiu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Zhandong Qiu, maxella1719@163.com
Zheng Liu, lzwcy@xwhosp.org

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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