We identified 3 patients with confirmed CNS nocardiosis.(2/3) patients had N farcinica and (1/3) patient had N cyriacigeorgica. The mean age was (31.6 years; range, 5–65 years). (2/3) patients presented with acute lung infection and (1/3) patient presented with painful skin nodules. All patients were immunocompromised given their organ transplant history. All patients were on chronic immunosuppressive agents. (2/3) were on prednisone and Tacrolimus and (1/3) on prednisone and Cyclosporine.MRI brain with contrast showed (3/3) supratentorial , grey white matter junctions target like brain abscesses with ring enhancement. (1/3) had deep whit matter abscess ,(1/3) cerebellar abscess,(2/3) had ependymal abscess,(1/3) had leptomeningeal enhancement.All patients were treated with combined regimen, trimethoprim/sulfamethoxazole and Imipenem, for a total period of 12 months with MRI brain follow up, all patients had near resolution of brain lesions.

CNS nocardiosis was observed only in immunocompromised patients with history of organ transplantation, all of the patients treated with TMP-SMX for more than 12 months, imaged based duration with significant recovery and no relapse.Brain MRI findings mainly showed grey white matter junction ring enhancing lesions with ependymal abscess and leptomeningeal enhancement,These findings may be helpful in diagnosing CNS nocardiosis.