Nocardia farcinicamasquerading as intracerebral metastases in advanced metastatic prostatic cancer

Abstract

A 67-year-old man with metastatic prostate cancer and underlying asymptomatic pancytopenia presented with a 1-week history of general malaise, left leg weakness and facial numbness. Initial brain imaging demonstrated two rim-enhancing lesions felt to represent intracerebral metastasis. Following neurosurgical referral, a multidisciplinary meeting decision was made for best supportive care and dexamethasone was given. He developed multiple cutaneous lesions, which on incision and drainage revealed Nocardia farcinica. Repeat brain imaging showed enlargement of the existing cavitating lesions and appearance of new lesions, now typical of cerebral abscesses. A diagnosis of disseminated nocardiosis with cutaneous and intracerebral infection was reached. He started taking empirical treatment with intravenous meropenem, co-trimoxazole and subsequent addition of amikacin, with little improvement. On further review of sensitivities, moxifloxacin was added. Following over 1 month of antimicrobial treatment, his neurological symptoms, cutaneous lesions and repeat MRI of the brain had improved.

Treatment of Nocardial Brain Abscess in a Patient With Systemic Lupus Erythematosus and Idiopathic Thrombocytopenic Purpura: Case Report and a Review of the Literature

“…Good outcomes are expected with prompt diagnosis and initiation of appropriate treatment. Differentials include intrinsic or metastatic brain tumors, toxoplasmosis, meningioma, cerebral tuberculosis, and cerebral Mycobacterium non-tuberculosis infections [11][12][13][14][15]. Management options include surgery, antibiotics if the organism has been identified from a specimen, cerebrospinal fluid or blood cultures, or a combination [16,17].…”

The Clinical, Diagnostic, Therapeutic, and Prognostic Characteristics of Brain Metastases in Prostate Cancer: A Systematic Review

“…Recently, there has been a trend showing an increase in the number of PCa cases with a reported metastatic brain lesion. Tis brings to light the numerous challenges we face in terms of properly understanding, diagnosing, and managing PCa patients with BMs [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Given the lack of knowledge regarding the issue of metastatic brain lesions in PCa, we decided to comprehensively and systematically review the latest evidence regarding the clinical manifestations, diagnosis, treatment, and prognosis of the BMs in PCa.…”