Background: At times the radiological resolution of a lesion may not be accompanied by clinical improvement,causing a diagnostic dilemma for the treating physician. We report one such case.Case Report: A 59 year old male presented with six weeks history of cough and haemoptysis. Initially the chest X-ray and CT were consistent with bronchogenic carcinoma however bronchoscopy did not show an endobronchial lesion. After a course of antibiotic, a follow up CT showed marked resolution of the lesion suggesting a resolving pneumonic infection however the patient continued to deteriorate and later presented with worsening mental function and back pain. CT brain showed multiple ring enhancing lesions requiring craniotomy and drainage. CT abdomen showed a psoas abscess which was drained. Microbiology was consistent withNocardial infection. He responded to long term Cotrimoxazole and Ceftrioxone.Conclusions: When radiological and clinical impressions don’t match along the follow up of a patient, the clinical impression is generally more accurate.

Keywords: Nocardia, cerebral abscesses, immunocompromised infections