Segev Gabay1,2, Michal Yakubovsky3,4, Ronen Ben-Ami5, Rachel Grossman1. 1. Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel. 2. Department of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel. 3. Departments of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel. michalya@tlvmc.gov.il. 4. Department of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel. michalya@tlvmc.gov.il. 5. Departments of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Nocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids. CASE PRESENTATION: A 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae. CONCLUSIONS: Nocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.
BACKGROUND: Nocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids. CASE PRESENTATION: A 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae. CONCLUSIONS: Nocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.
Authors: Kelvin Rivera; Jeffrey Maldonado; Aixa Dones; María Betancourt; Ricardo Fernández; Miguel Colón Journal: Oxf Med Case Reports Date: 2017-12-11