Successful treatment of brain abscess caused by Nocardia in an immunocompromised patient after failure of co-trimoxazole.
Disseminated infection caused by Nocardia asteroides is a fairly rare entity occurring mostly in immunocompromised states. Metastatic brain abscesses are a frequent and ominous complication. We report on a patient whose underlying disease was stage II pulmonary sarcoidosis. He acquired disseminated N. asteroides infection while on immunosuppressive therapy with prednisolone. After the generally recommended therapy with co-trimoxazole (trimethoprim/sulfamethoxazole) proved ineffective in controlling his brain abscesses, the lesions of the central nervous system completely resolved under a combination of oral rifampicin with i.v. imipenem, followed by oral rifampicin and ampicillin/clavulanic acid.
Overkamp
D
D
Abt. Neuroradiologie, Eberhard-Karls-Universität, Tübingen, Germany.
Waldmann
B
B
Lins
T
T
Lingenfelser
T
T
Petersen
D
D
Eggstein
M
M
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy*; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016867:Immunocompromised Host; D008297:Male; D009617:Nocardia Infections / Q000188:drug therapy*; D009616:Nocardia asteroides; D012293:Rifampin / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D002969:Clavulanic Acids; D019818:Clavulanic Acid; D015378:Imipenem; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D012293:Rifampin