A 25-year-old nurse had a 3-month history of sore throat and headache, a 2-month history of intermittent fever, and a 1-month history of dizziness. Neurological examination showed bilateral nystagmus, left-sided sensory loss, ataxia, and subtle meningeal signs. Brain and cervical spinal cord MRI revealed multiple enhancing lesions with central vein features. Cerebrospinal fluid (CSF) analysis showed increased pressure (240 mmH2O) and leukocytosis (140 × 106/l). Serum MOG-IgG was positive (1:32), mNGS confirmed Nocardia nova infection. Initial treatment included trimethoprim-sulfamethoxazole, amikacin, and imipenem-cilastatin, later the regimen was modified to trimethoprim-sulfamethoxazole plus minocycline. After treatment, pressure and CSF leukocytes normalized, mNGS was negative, and MRI showed regression of the lesion. The symptoms completely disappeared 2 months after the start of treatment.