Nocardial brain abscess in a renal transplant recipient successfully treated with triple antimicrobials.
Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.
Sabeel
A
A
Department of Medicine, King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia.
Alrabiah
F
F
Alfurayh
O
O
Hassounah
M
M
D000583:Amikacin / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology*; D002443:Ceftriaxone / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy* / Q000209:etiology; D009616:Nocardia asteroides; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin