title: "Primary" nocardial brain abscess in a renal transplant patient.
abstract: BACKGROUND
  Intracranial abscesses are rare among transplant recipients, and Nocardia is responsible for less than 2 % of them. Nocardiosis, a chronic infection and is difficult to treat. Primary infection involves lungs and eventually disseminates. Primary nocardial abscesses are rare and we report a case from Sri Lanka.
  
  
  METHODS
  A 38 year old Sri Lankan, who has received his 2nd ABO matched live donor transplantation, which was complicated with perinephric hematoma and massive transfusion syndrome. He presented with fever, worsening headache and papilledema. An urgent magnetic resonance image (MRI) showed an occipital abscess with midline shift. Craniotomy and drainage followed by 3 week course of imipenem and levofloxacin, which rendered him symptom free. After 12 months he has stayed recurrence free. Imaging and bacteriology of the respiratory tract failed to demonstrate Nocardia infection.
  
  
  CONCLUSIONS
  Isolated (Primary) nocardial brain abscess are rare, and have an excellent response to medical therapy. We achieved a good response from a relatively short course of antibiotics (not using sulfonamides, due to allergy), where long courses of antibiotic had been the norm.
authors.affiliation: University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo, 9, Sri Lanka. rangamw2003@yahoo.com.
authors.forename: Ranga Migara
authors.initials: RM
authors.lastname: Weerakkody
authors.affiliation: University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo, 9, Sri Lanka. dhammika27@yahoo.com.
authors.forename: Dhammika Randula
authors.initials: DR
authors.lastname: Palangasinghe
authors.affiliation: Department of Neurosurgery, National Hospital of Sri Lanka, Regent Street, Colombo, 9, Sri Lanka. wadanambis@yahoo.com.
authors.forename: Saman
authors.initials: S
authors.lastname: Wadanambi
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, 8, Sri Lanka. erangasw@gmail.com.
authors.forename: Eranga Sanjeewa
authors.initials: ES
authors.lastname: Wijewikrama
mesh_terms: D000328:Adult; D001922:Brain Abscess / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009615:Nocardia / Q000472:pathogenicity*; D009617:Nocardia Infections / Q000150:complications* / Q000382:microbiology; D013188:Sri Lanka