Nocardia cyriacigeorgica brain abscess in a patient on low dose steroids: a case report and review of the literature

Abstract

Background Nocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids. Case presentation A 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae. Conclusions Nocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.

Middle cerebellar peduncle approach for Nocardia brainstem abscess: illustrative case

“…1 Since its initial sequencing, there have been several reported cases of N. cyriacigeorgica causing intracranial abscesses (Table 1). [1][2][3][4][5][6][7][17][18][19][20][21] Notably, in contrast with most previously documented cases, our patient was previously healthy and active, spending much of his time doing yard work on his farm-like property in suburban Pennsylvania. Although his Nocardia exposure ostensibly occurred outdoors via the pulmonary route, his lungs were clear throughout his course of illness.…”

“…Nocardia brain abscesses are rare but deadly, because they carry a greater than 50% mortality rate. 6 They are most frequently encountered in immunocompromised hosts, entering the body through the lungs and spreading from the pulmonary source to the brain via the bloodstream. Isolated involvement of nonhemispheric regions has been reported.…”

“…1,3,4 Nocardia intracranial abscesses are exceedingly rare, present in less than 2% of all nocardiosis cases, but the mortality rate of these abscesses is three times higher than other intracranial abscesses. [5][6][7] There have been isolated reports of brainstem involvement in disseminated central nervous system (CNS) infection, but very few with solitary abscess of the brainstem (Table 1). We report a case of an immunocompetent patient with a pontine abscess caused by N. cyriacigeorgica, which was evacuated via the retrosigmoid middle cerebellar peduncle approach.…”

Nocardia farcinica brain abscess with torque teno virus co-infection: A case report

“…The higher incidence of nocardial brain abscesses in older adults may result from immunosenescence, partly due to the excessive production of proinflammatory cytokines by macrophages and fibroblasts which are critical for the development of nocardial brain abscess [ 12 , 13 ]. Nocardia has been labelled as a “great mimic” because of the diversity of its clinical presentation, and the clinical presentation of nocardial brain abscesses can be difficult to distinguish from primary brain tumours, metastases, and ischaemic stroke [ [14] , [15] , [16] , [17] ]. Notably, CT and conventional MRI are inadequate for distinguishing brain abscesses from other ring-enhancing lesions, particularly intracranial metastatic malignancies.…”

A Rare Case of a Subcutaneous Abscess Caused by Nocardia cyriacigeorgica in an Immunocompetent Patient

“… 3 , 4 The most typical clinical manifestations of N. cyriacigeorgica are pleuropulmonary and disseminated infection mainly involved in patients with acquired immunodeficiency syndrome (AIDS), corticosteroid maintenance, ongoing malignancy and those with solid organ transplant and hematopoietic stem cell transplant recipients, who are deficient in T cell-mediated immunity. 5–10 Nocardiosis caused by N. cyriacigeorgica is rare in immunocompetent hosts, usually acquired by wound infection after invasive surgery and inoculation on damaged skin with festering and scabbing. 11 N. cyriacigeorgica -related subcutaneous abscesses are potentially leading to clinical misdiagnosis because they rare in clinical and asymptomatic with insidious manifestations.…”