This conference opened with a patient on high-dose steroids who developed sepsis with multiple subcutaneous abscesses after a chicken coop injury, along with a rim-enhancing frontal brain abscess. Operative cultures ultimately grew Nocardia farcinica from the leg and brain, with additional organisms from soft tissue cultures, prompting discussion of disseminated nocardiosis, CNS involvement, susceptibility-guided therapy, and the practical difficulties of prolonged multi-drug treatment.
The second case involved a young patient referred for a positive PPD after previously negative testing, with a negative Quantiferon and a history suggestive of environmental NTM exposure. The teaching portion used this case to review where nontuberculous mycobacteria live, why geography and water/soil exposures matter, and how NTM exposure can complicate interpretation of tuberculin skin testing.