Background: Nocardia is a rare pathogen of mainly immunocomprised patients. Only two cases of nocardiosis have previously been identified in Iceland.

Case description: A 92-year-old male on glucocorticoid therapy with metastatic bladder cancer presented with two weeks history of progressive swelling and erythema of the hand and deteriorating cognitive functioning. A brain lesion and pulmonary nodules were identified and Nocardia farcinia was cultured from a hand abscess. The patient was initially treated with trimethoprim/sulfamethoxazole but because of rapid deterioration and old age an end-of-life decision was made.

Conclusion: This case of nocardiosis illustrates the importance of uncommon opportunistic infections in immunocompromised Icelandic patients.

Figure 1. Swelling of the right hand. Photo taken on the fifth day of admission.
 
Figure 2. CT scan of the brain. In the right occipital lobe there is a 3x2 cm contrast enhancing lesion (arrow) with adjacent parenchymal oedema.