Objective: To describe lessons learned from the case of a marine who survived severe battlefield polytrauma, but died 8 weeks later while undergoing inpatient TBI rehabilitation. Hypothesis: Optimal care of combat-related polytrauma with TBI requires effective communication across levels of care and a high index of suspicion regarding unusual infections. Case: This 21-year-old man suffered severe head, spine, chest, and abdominal injuries when his vehicle struck an improvised explosive device in Iraq. He received life-sustaining treatment at the site of injury, including tracheal intubation and placement of a chest tube. Method: Detailed review of management from the battlefield through acute care settings to rehabilitation. Results: The patient underwent multiple operations including cranioplasty for a large open skull defect. Cerebrospinal fluid (CSF) was suggestive of infection. During rehabilitation he showed initial improvement, but developed fever and leukocytosis and ultimately had a seizure and cardiac arrest. Autopsy revealed purulent meningitis. Nocardia was identified by special staining of brain tissue. Conclusions: In this first reported case of central nervous system Nocardia infection from the war in Iraq, physicians during the patient's rehabilitation were unaware that CSF had been abnormal prior to transfer from the acute setting. Furthermore, in part because the patient was on broad-spectrum antibiotics, they did not obtain CSF for examination nor did they give serious consideration to the possibility of unusual infections.