With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.

Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. Only 5 cases have been reported in the United States. We present a case of disseminated Nocardia beijingensis involving the lung, subcutaneous tissue, and central nervous system of an immunocompetent patient.Clinical Findings: A 60-year-old immunocompetent male with no significant medical history presented to our hospital after a complicated medical course, beginning with vague respiratory complaints. His initial work-up revealed a large mass of unclear etiology in the right upper lung. A month later, he had a syncopal episode and then developed focal neurologic deficits.Sputum cultures obtained after the patient's syncopal episode grew gram-positive rods. Results of a computed tomography of the chest showed a new 17-mm subcutaneous mass. The mass was biopsied, which revealed gram-positive rods with partial acid-fast staining. Week later, results of magnetic resonance imaging of his brain showed multiple enhancing lesions with vasogenic edema scattered throughout. A tissue culture from his chest mass was sent to the Mayo Clinic and ultimately grew Nocardia beijingensis. The patient was started on the appropriate antibiotic therapy and has made significant clinical improvement. Conclusions:Though Nocardia is often associated with an immunocompromised state, it can also occur in patients with pulmonary findings and evidence of disseminated disease, particularly central nervous system manifestations, regardless of immune status. A high index of suspicion is needed, as definitive diagnosis often takes weeks due to the slow-growing nature of Nocardia species.