J Neurocrit Care.  2023 Dec;16(2):107-110. 10.18700/jnc.230035.

Disseminated nocardiosis including cerebral nocardiosis caused by Nocardia farcinica: a case report

• Song B
• Kim DY
• Kim YJ
• Woo HG

• KMID: 2549488
• DOI: http://doi.org/10.18700/jnc.230035

Abstract

Background
As nocardiosis presents with nonspecific symptoms, its diagnosis is often difficult, resulting in high mortality. Here, we report a rare case of disseminated Nocardia farcinica infection that was successfully managed with a combination of antibiotic therapies.
Case report
A 71-year-old man with idiopathic thrombocytopenia purpura presented with sudden-onset motor aphasia, motor weakness of the right limb, and fever. Brain magnetic resonance imaging revealed multiple scattered diffusion-restricted lesions. Multiple cutaneous and peritoneal nodules were also identified. We performed full-length 16S ribosomal ribonucleic acid (rRNA) sequencing and obtained basic local alignment search tool results against the National Center for Biotechnology Information 16S rRNA database, which showed the best match to be N. farcinica. After maintaining the antibiotics for approximately 56 days, the patient recovered full consciousness, and the motor weakness of the right limb improved.
Conclusion
Timely diagnosis of disseminated or cerebral nocardiosis and treatment with appropriate antibiotics are crucial for a desirable clinical outcome.

Keyword

Nocardiosis; Brain abscess; Disseminated; 16S rRNA sequencing

Figure

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  Fig. 1. Magnetic resonance imaging of the patient. (A-C) Multiple scattered diffusion-restricted lesions in both hemispheres, thalami, cerebella, and right basal ganglia are observed on the initial diffusion-weighted image. (D-F) Rim-enhancing lesions (arrows and arrowheads) with associated edema on T1 weighted imaging and a dark signal on T2 weighted imaging and consistent wall thickness suggest a brain abscess.

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