Cerebral nocardiosis.
Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess was suggested. Patient underwent right sided craniotomy with aspiration of abscess. Serum Gram staining showed branching Gram-positive rods, and serum culture showed colonies of Nocardia Asteroides. He was started on Sulfamethoxazole-Trimethoprim. On follow-up examination, the patient showed marked improvement clinically and was discharged in stable condition on long term antibiotic therapy. This case highlights the importance of including nocardia on the differential diagnosis especially in patients who present with abnormal MRI scan findings that mimic tuberculoma or neoplastic disease. Clinical awareness of this condition could expedite the diagnostic process and help improve morbidity and mortality.
Department of Radiology, Aga Khan University Hospital, Karachi.
Rohana
R
Naqi
Humera
H
Ahsan
Muhammad
M
Azeemuddin
D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003399:Craniotomy; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D009616:Nocardia asteroides / Q000302:isolation & purification*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination