Disseminated Nocardia transvalensis infection with osteomyelitis and multiple brain abscesses.
A case of Nocardia transvalensis osteomyelitis and cerebral abscesses is described. To the authors' knowledge, the patient described here represents the first reported case of primary N. transvalensis leg abscess with contiguous osteomyelitis of the femur and secondary brain abscesses. The literature on nocardial osteomyelitis and cerebral nocardiosis is reviewed, and treatment of both conditions is discussed. The interactions between the immune system and nocardial organisms are described, as well as the host defense defects in diabetic patients as they relate to pathogenicity of the bacteria. Finally, the patient's paradoxical therapeutic response of resolving brain abscesses with concomitant unresolving osteomyelitis is discussed, as well as its implications for managing similar cases in the future.
Division of Infectious Diseases, Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Texas A&M University Health Sciences Center, College of Medicine, Temple, Texas 76508, USA. jpmontoya@pol.net
Jean-Paul
JP
Montoya
John L
JL
Carpenter
Gary P
GP
Holmes
Douglas L
DL
Hurley
Richard
R
Winn
D000328:Adult; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001774:Blood Chemical Analysis; D001922:Brain Abscess / Q000150:complications / Q000175:diagnosis*; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009615:Nocardia / Q000145:classification*; D009617:Nocardia Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents