Primary nocardial meningitis in systemic lupus erythematosus.
Nocardia is an important but often overlooked opportunistic infection agent in immunocompromised hosts. Nocardiosis is primarily pulmonary; central nervous system involvement, usually in the form of brain abscess, is less common. Primary nocardial meningitis without associated brain abscess and pulmonary lesion is extremely rare and poses a formidable diagnostic challenge. We report on a patient with systemic lupus erythematosus who presented with a clinical picture of chronic meningitis which failed to respond to empirical antibiotic treatment. She deteriorated and succumbed. Post-mortem examination showed nocardial meningitis without associated brain abscesses. Nocardial meningitis should be considered a differential diagnosis of subacute meningitis in immunocompromised hosts.
Mok
C C
CC
University Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
Lau
C S
CS
Poon
S P
SP
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis; D009617:Nocardia Infections / Q000150:complications* / Q000175:diagnosis