Case of disseminated Nocardia beijingensis, initially diagnosed and treated by health department as tuberculosis, presented with worsening symptoms and new lesions. Adjustment to antinocardial treatment resulted in significant clinical and radiographic improvement. Maintain a high index of suspicion for Nocardia in patients diagnosed with tuberculosis with worsening lesions despite therapy.

Granulomatous amoebic encephalitis (GAE) caused by Balamuthia mandrillaris is a rare subacute infection with exceptionally high mortality. Diagnosis is typically made by brain biopsy or at autopsy. Detection of Balamuthia mandrillaris cell-free DNA by next-generation sequencing of plasma enabled rapid, noninvasive diagnosis in a case of amoebic encephalitis.

HighlightsA case report of an HIV patient with refractory acute respiratory failure secondary to Pneumocystis jiroveci (PCP) and Cytomegalovirus (CMV) pneumonitis.Diagnostic and therapeutic dilemma of treating CMV in such a clinical scenario.Role of corticosteroids in treatment of PJP and risk factors for CMV.Characteristic findings on CT scan and BAL cytology.