Nocardia asteroides, a gram-positive, branching rod, is a soil bacterium and an opportunistic pathogen, which frequently causes infection in immuno-compromised hosts
Here we report a 37-year-old man who had nocardial brain abscess in the course of immunosuppressive treatment with prednisobne and cyclophosphamide for systemic lupus erythematosus.
He complanined of intermittent right frontal and temporal headache for 1 month. He visited to emergency room due to sudden generalized seizures for about 10 minutes. On neurologic examination, he was alert, and increased deep tendon reflex on
upper
and
lower extremities were noted. On cerebrospinal fluid examination, cell counts and microbial study was normal except elevated CSF pressure (300mm CSF). On brain magnetic resonance imaging, variable sized multiple cystic mass lesions with rim
enhancement
were founded in frontal, temporal lobes and basal ganglia areas. We performed osteoplastic craniotomy on frontal cystic mass lesion to confirm the diagnosis. A thick encapsulated 4.5x2.5x2cm-sized cystic mass was enucleated. The yellowish creamy
pus
without odor was contained in multi-septated cystic mass. After Nocardia asteroides was identified in microbial culture study, we initiated antibiotic treatment (bactrim and cefortaxim). He was treated with bactrim for mare than 6 monthes and
maintained
stable condition.
|