title: Primary brain abscess with Nocardia farcinica in an immunocompetent patient.
abstract: In this paper, we describe a case of an immunocompetent patient with cerebral nocardiosis. The onset was with loss of strength, paresthesia and focal epilepsy of the left arm. MRI showed on T2-weighted sequences a hyperintense central area of pus surrounded by a well-defined hypointense capsule and surrounding edema; on T1-weighted sequences a hypointense necrotic cavity with ring enhancement following administration of intravenous gadolinium. The patient underwent surgical excision of the abscess but culture from the specimen was negative. After 40 days of empirical antimicrobial therapy he developed neurological deterioration with focal epilepsy. A new MRI documented an enlargement of the hypointense lesion in the right frontal-parietal region. A second craniotomy with drainage of the abscess was performed; cultures yielded Nocardia farcinica. Therapy with trimethoprim/sulfamethoxazole, amikacin and meropenem was given for 35 days, and clinical and radiological improvement was observed. Home therapy was done with oral trimethoprim/sulfamethoxazole. Currently, 5 months from the second surgery, the patient can walk with support and no new episodes of epilepsy occurred. Side effects were absent from therapy. The MRI appearance of the brain lesion has improved, with a decrease in size, surrounding edema and ring enhancement.
authors.affiliation: Department of Experimental Medicine and Biochemical Science, Section of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Malincarne
authors.forename: Massimo
authors.initials: M
authors.lastname: Marroni
authors.forename: Claudio
authors.initials: C
authors.lastname: Farina
authors.forename: Guido
authors.initials: G
authors.lastname: Camanni
authors.forename: Marina
authors.initials: M
authors.lastname: Valente
authors.forename: Barbara
authors.initials: B
authors.lastname: Belfiori
authors.forename: Stefano
authors.initials: S
authors.lastname: Fiorucci
authors.forename: Piero
authors.initials: P
authors.lastname: Floridi
authors.forename: Angela
authors.initials: A
authors.lastname: Cardaccia
authors.forename: Giuliano
authors.initials: G
authors.lastname: Stagni
mesh_terms: D001922:Brain Abscess / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D001929:Brain Edema / Q000209:etiology; D004828:Epilepsies, Partial / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009617:Nocardia Infections / Q000150:complications* / Q000473:pathology / Q000601:surgery