Nocardia farcinica abscess of the cerebellum in an immunocompetent patient: A case report and review of the literature

Abstract

Nocardial brain abscesses are uncommon and rarely occur in patients without predisposing factors. They may be mistaken for gliomas or necrotic metastases, and surgical intervention may be required to make the diagnosis. We report the first case of Nocardia farcinica cerebellar abscess in a patient without immunosuppression. He presented to us with headache and instability beginning a week before. Brain magnetic resonance imaging (MRI) revealed a cystic lesion located at the right cerebellar hemisphere, hypointense in T1 and hyperintense in T2, with a fine wall that enhanced after injection of gadolinium. Image tests also showed a cavitated lesion at the upper lobule of the right lung. The patient underwent craniotomy and drainage of the cerebellar abscess. Initial post-operative treatment with linezolid produced a limited response. He was re-operated and vancomycin, imipenem and ciprofloxacin were added with an excellent outcome of the cerebellar and lung lesions.

A case report of brain abscess caused by Nocardia farcinica

“…Nocardia identification can be difficult because of the slowly growing pattern of the germ and low positive rate (colonies usually require at least 48 h of incubation although more commonly 3 to 5 days and up to 14 to 21 days), preferably in selective media [ 14 ]. To isolate Nocardia spp., multiple cerebrospinal fluid (CSF) specimens should be cultured to increase the yield, although it is not uncommon for the bacteria to be recovered only when direct pus is cultured [ 15 ].…”

A Dead Case Report From Brain Abscess Caused by Nocardia Farcinica

“…Nocardia identi cation can be di cult because of the slowly growing pattern of the germ and low positive rate (colonies usually require at least 48h of incubation although more commonly 3 to 5 days and up to 14 to 21 days), preferably in selective media [17].To Nocardia spp, multiple cerebrospinal uid (CSF) specimens should be cultured to increase the yield, although it is not uncommon for the bacteria to be recovered only when direct pus is cultured [18] .Certain laboratory techniques like mass spectrometry may help to identify the genus and species. The preferred methods for test of Nocardia are 16S rRNA gene analysis and other molecular techniques, such as restriction fragment length polymorphisms and multilocus sequence analysis.…”

Pulmonary Occupancy Combined Brain Abscess Caused by Nocardia Farcinica: Death Case Report and Literature Review

“…Nocardia identi cation can be di cult because of the slowly growing pattern of the germ (colonies usually require at least 48h of incubation although more commonly 3 to 5 days and up to 14 to 21 days), preferably in selective media [17]. To Nocardia spp, multiple cerebrospinal uid (CSF) specimens should be cultured to increase the yield, although it is not uncommon for the bacteria to be recovered only when direct pus is cultured [18].…”