Disseminated Nocardia infection with a lesion occupying the intracranial space complicated with coma: a case report

• Published in: BMC infectious diseases 2020-11, Vol.20 (1), p.856-5, Article 856
• Main Authors: Yu, Mei-Hong, Wu, Xiao-Xin, Chen, Chun-Lei, Tang, Song-Jia, Jin, Jian-Di, Zhong, Cheng-Li, Fu, Jing, Shi, Jie-Qin, Li, Lan-Juan
• Format: Article
• Language: English
• Subjects: Abscesses; Actinomycetales infections; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotic therapy; Antibiotics; Antimicrobial agents; Blood; Brain diseases; Bronchopulmonary infection; C-reactive protein; Care and treatment; Case Report; Case reports; Case studies; Cell culture; Coma; Coma - complications; Consciousness; Cyclophosphamide; Cyclophosphamide - adverse effects; Diagnosis; Diagnosis, Differential; Differential diagnosis; Drainage; Drug dosages; Drug resistance; Follow-Up Studies; Hospitals; Humans; Immunosuppressive Agents - adverse effects; Infections; Infectious diseases; Intracranial occupying lesion; Kidney diseases; Lesions; Leukocytes; Leukocytes (neutrophilic); Lungs; Magnetic Resonance Imaging; Male; Mesencephalon - diagnostic imaging; Mesencephalon - pathology; Muscles; Neutrophils; Nocardia; Nocardia - isolation & purification; Nocardia cyriacigeorgica; Nocardia Infections - complications; Nocardia Infections - diagnosis; Nocardia Infections - drug therapy; Nocardia Infections - microbiology; Patients; Prednisone; Proteins; Surgical drainage; Surgical drains; Thalamus - diagnostic imaging; Thalamus - pathology; Tomography Scanners, X-Ray Computed; Treatment Outcome; Ultrasonic imaging; Vacuum; Wound drainage
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05569-4

Disseminated Nocardia infection is a disease that is easily overlooked in patients with lesions occupying the intracranial space complicated with coma. Early diagnosis and treatment are crucial. A 65-year-old man was admitted to the First Affiliated Hospital of Zhejiang University in October 2018 with weakness in the right limbs for 3 days and altered consciousness for 1 day. Five months earlier, he had been diagnosed with membranous kidney disease and had received cyclophosphamide and prednisone. At admission, the white blood cell count was 1.37 × 10 /L (with 86.4% neutrophils), and C-reactive protein was 115.60 mg/L. Imaging examinations revealed a lesion occupying the intracranial space, lung infection, and multiple abscesses in the rhomboid muscle. The abscesses were drained. Pus culture confirmed Nocardia cyriacigeorgica infection. With antibiotics and vacuum-sealed drainage of the back wound, the patient improved and was discharged from the hospital. This case report shows that infection should be considered during the differential diagnosis of lesions in the intracranial space, especially in patients receiving immunosuppressive treatment. In patients with disseminated N. cyriacigeorgica infection, combination antibiotic therapy and surgical drainage of localised abscesses can be effective.