Disseminated Nocardia infection with a lesion occupying the intracranial space complicated with coma: a case report
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CASE REPORT
Open Access
Disseminated Nocardia infection with a lesion occupying the intracranial space complicated with coma: a case report Mei-Hong Yu1†, Xiao-Xin Wu1†, Chun-Lei Chen1†, Song-Jia Tang2, Jian-Di Jin1, Cheng-Li Zhong1, Jing Fu1, Jie-Qin Shi1 and Lan-Juan Li1*
Abstract Background: Disseminated Nocardia infection is a disease that is easily overlooked in patients with lesions occupying the intracranial space complicated with coma. Early diagnosis and treatment are crucial. Case presentation: A 65-year-old man was admitted to the First Affiliated Hospital of Zhejiang University in October 2018 with weakness in the right limbs for 3 days and altered consciousness for 1 day. Five months earlier, he had been diagnosed with membranous kidney disease and had received cyclophosphamide and prednisone. At admission, the white blood cell count was 1.37 × 1010/L (with 86.4% neutrophils), and C-reactive protein was 115.60 mg/L. Imaging examinations revealed a lesion occupying the intracranial space, lung infection, and multiple abscesses in the rhomboid muscle. The abscesses were drained. Pus culture confirmed Nocardia cyriacigeorgica infection. With antibiotics and vacuum-sealed drainage of the back wound, the patient improved and was discharged from the hospital. Conclusions: This case report shows that infection should be considered during the differential diagnosis of lesions in the intracranial space, especially in patients receiving immunosuppressive treatment. In patients with disseminated N. cyriacigeorgica infection, combination antibiotic therapy and surgical drainage of localised abscesses can be effective. Keywords: Nocardia cyriacigeorgica, Intracranial occupying lesion, Antibiotic therapy, Surgical drainage
Background Nocardiosis is an acute, subacute, or chronic infectious disease that may be localised or disseminated; it is characterised by suppurative or granulomatous inflammation. It is usually diagnosed in adults aged 30–50 years, with male predominance, and mostly affects individuals with severe immune dysfunction [1, 2]. Patients mostly present with non-specific features such as fever, cough * Correspondence: [email protected] † Mei Hong Yu, Xiao-Xin Wu and Chunlei Chen contributed equally to this work. 1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, Zhejiang, China Full list of author information is available at the end of the article
with expectoration, chest pain, fatigue, poor appetite, high white blood cell and neutrophil counts, and elevated blood inflammatory indices (C-reactive protein, calmodulin). The diagnosis is therefore easily missed [3]. Confirmation of diagnosis requires isolation of Nocardia bacteria from blood, sputum, pus, drainage, tissue, or cerebrospinal fluid specimens. We report a rare case of di
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