Nocardia araoensis causing brain abscess

• Published in: Asian journal of neurosurgery 2019-07, Vol.14 (3), p.952-956
• Main Authors: Joshua, Shejoy, Babu, Rachana, Warrier, Anup, Panikar, Dilip
• Format: Article
• Language: English
• Subjects: Anemia; Brain abscess; Care and treatment; Case Report; Central nervous system; Corticosteroid drugs; Diabetes mellitus; Diagnosis; Glucocorticoids; Health aspects; Hemolytic anemia; Imipenem; Infection; Meropenem; Morbidity; Mortality
• ISSN: 1793-5482; 2248-9614
• DOI: 10.4103/ajns.AJNS_66_19

Nocardial brain abscess is a rare central nervous system infection with high morbidity and mortality. Most of the human infections, i.e., about 90%, are due to Nocardia asteroides group comprising N. asteroides complex, Nocardia farcinica, and Nocardia nova. Other species rarely cause human infections. Here, we report a case of left parieto-occipital abscess caused by a rare species, Nocardia araoensis, its diagnosis, treatment options, and review of literature. A 73-year-old male, known case of diabetes mellitus, on prolonged oral corticosteroid for autoimmune hemolytic anemia presented with a 1-month history of memory deficit and gait imbalance. On examination, he had a right inferior quadrantanopia and hemiparesis. Magnetic resonance imaging showed a multiloculated ring-enhancing lesion in the left parieto-occipital region. Navigation-assisted biopsy was done. The organism isolated was N. araoensis. He was treated successfully with prolonged course of antibiotics which resulted in complete clinical and radiological resolution. N. araoensis is a rare cause of brain abscess and needs to be suspected in immunocompromised individuals. Early diagnosis and prolonged treatment can result in complete clinical and radiological resolution.