title: Multiple nocardial abscesses of the brainstem and spinal cord diagnosed after an open biopsy through a cervical partial central corpectomy: case report.
abstract: Nocardiosis of the central nervous system is a challenging and difficult diagnosis for the clinician. The combination of infections of the brain and spinal cord is even more rare. The authors report on a patient with multiple lesions in the brainstem and cervical spinal cord. This 81-year-old immunocompetent woman presented with symptoms of progressive walking difficulty and ataxia. The results of an extensive workup with laboratory investigation, MRI, lumbar puncture, positron emission tomography (PET), and bone marrow biopsy remained inconclusive. Only after an open biopsy of a cervical lesion by an anterior approach through a partial central corpectomy of the cervical spine, was the diagnosis of nocardiosis made, allowing for specific antibiotic treatment.
authors.affiliation: Departments of 1 Neurology.
authors.forename: Ian
authors.initials: I
authors.lastname: Peeters
authors.affiliation: Radiology.
authors.forename: Jan W
authors.initials: JW
authors.lastname: Casselman
authors.affiliation: Nephrology and Infectious Diseases, and.
authors.forename: Stefaan J
authors.initials: SJ
authors.lastname: Vandecasteele
authors.affiliation: Neurosurgery, Hospital AZ Sint-Jan, Brugge, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Janssen
authors.affiliation: Neurosurgery, Hospital AZ Sint-Jan, Brugge, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Regaert
authors.affiliation: Neurosurgery, Hospital AZ Sint-Jan, Brugge, Belgium.
authors.forename: Nikolaas
authors.initials: N
authors.lastname: Vantomme
authors.affiliation: Departments of 1 Neurology.
authors.forename: Ludo J
authors.initials: LJ
authors.lastname: Vanopdenbosch
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D001933:Brain Stem / Q000473:pathology*; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009615:Nocardia; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: PCR = polymerase chain reaction; biopsy; brainstem; cervical spine; infection; nocardiosis; partial corpectomy; spinal cord