scholarly journals A complicated case of an immunocompetent patient with disseminated nocardiosis

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Chad J. Cooper ◽  
Sarmad Said ◽  
Maryna Popp ◽  
Haider Alkhateeb ◽  
Carlos Rodriguez ◽  
...  
Keyword(s):  
Tissue Sample ◽  
Vasogenic Edema ◽  
Brain Magnetic Resonance Imaging ◽  
Empiric Therapy ◽  
Immunocompetent Patient ◽  
Lung Abscess ◽  
Lower Extremity Weakness ◽  
Brain Abscesses ◽  
Disseminated Nocardiosis ◽  
Hispanic Male

Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia <em>wallacei</em> species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying <em>Nocardia</em> infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.

scholarly journals Lung Abscess With Metastatic Brain Abscesses (MBA) Due to Steptococcus Anginosus (SA) in an Immunocompetent Patient: A Rare Case Report

CHEST Journal ◽  
2016 ◽  
Vol 150 (4) ◽  
pp. 187A
Author(s):  
Ahad Ayaz ◽  
Chintan Desai ◽  
Siddique Chaudhary ◽  
John Youssef ◽  
Susan Smith
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Immunocompetent Patient ◽  
Lung Abscess ◽  
Rare Case Report ◽  
Brain Abscesses

scholarly journals Klebsiella brain abscess in an immunocompetent patient: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Clay Wu ◽  
Semi Han ◽  
Ahmet Baydur ◽  
Brett Lindgren
Keyword(s):  
Computed Tomography ◽  
Klebsiella Pneumoniae ◽  
Brain Abscess ◽  
Mental Status ◽  
Klebsiella Oxytoca ◽  
Brain Magnetic Resonance Imaging ◽  
Altered Mental Status ◽  
Immunocompetent Patient ◽  
Normal Limits ◽  
Brain Abscesses

Abstract Background Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology. Case presentation A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures. Conclusion High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.

scholarly journals 1416. Nocardia beijingensis: A Rare and Unusual Cause of Intracranial Abscess

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S515-S516
Author(s):  
Lakshpaul Chauhan ◽  
Nirali Vassa ◽  
Elizabeth Henderson ◽  
Ateeq Mubarik ◽  
Danish Siddiq ◽  
...  
Keyword(s):  
Vasogenic Edema ◽  
Cranial Nerves ◽  
The United States ◽  
Immunocompetent Patient ◽  
Gram Positive ◽  
Scalp Lesion ◽  
Low Glucose ◽  
Cerebral Nocardiosis ◽  
Disseminated Nocardiosis

Abstract Background Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis. Methods We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB). Results A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea 3 days prior to admission that resolved however, her mentation significantly deteriorated to where she was unable to perform simple chores around the house. Pertinently she had resection of lung mass 2 months prior to admission which found to be benign. Vital sign at admission was stable and on examination, the patient was alert and oriented, however, lethargic appearing. Neurological examination was pertinent for expressive aphasia; however, cranial nerves II-XII were grossly intact. The patient was also found to have a 3 cm by 4 cm, tender, cystic lesion on the left-sided occipital scalp. The remainder of the physical examination was unremarkable. Admission laboratories were remarkable for leukocytosis and hyperglycemia. MRI of the brain was completed that showed multiple areas of vasogenic edema and multiple nodules with the largest being 1.8 cm suggestive of abscesses. She was started empirically on vancomycin, ceftriaxone, metronidazole, and ampicillin. Cerebral spinal fluid showed neutrophilic pleocytosis, low glucose, and high protein. Initial cultures including CSF were negative. Left-sided occipital scalp lesion was excised and sent for pathology and culture. Initial cultures showed gram-positive bacilli, so antibiotics were de-escalated to sulfamethoxazole/trimethoprim and ceftriaxone. Repeat imaging showed improving abscess, and final cultures resulted in NB. Conclusion NB is believed to have originated in Southeast Asia. NB has been associated mainly with infections in immunocompromised. In the United States, the two only other cases of NB described in immunocompetent hosts were interestingly from Florida as well. Disclosures All authors: No reported disclosures.

Excellent Outcome of Acute Necrotizing Encephalopathy in an Adult With Bacterial Infections, Case Report

2021 ◽  
pp. 194187442199137
Author(s):  
Yan Wang ◽  
John R. Younce ◽  
Joel S. Perlmutter ◽  
Soe S. Mar
Keyword(s):  
Differential Diagnosis ◽  
Bacterial Infections ◽  
Vasogenic Edema ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Necrotizing Encephalopathy ◽  
Excellent Outcome ◽  
Intravenous Antibiotics ◽  
Acute Necrotizing ◽  
Supportive Management

Acute necrotizing encephalopathy (ANE) is a rare para-infectious encephalopathy that classically occurs in children. However, ANE should be considered in the differential diagnosis of adults with symmetric brain lesions after a prodromal illness given recent reports of coronavirus disease of 2019 (COVID-19) to presumably cause ANE in adults. We report a case of a 29-year-old male presenting with fever, malaise, and rapid deterioration into coma. Brain magnetic resonance imaging revealed multifocal symmetric areas of diffusion restriction and surrounding vasogenic edema involving bilateral thalami, pons and cerebellar hemispheres with a core of susceptibility artifact, and minimal thalamic contrast enhancement, most consistent with ANE. Extensive infectious workup revealed isolated Escherichia coli and Neisseria gonorrhoeae in his urine. Despite the severe encephalopathy on initial presentation, the patient improved with intravenous antibiotics and supportive management with minimal residual deficits at 9 months follow-up. We aim to provide an overview of the radiological features, differential diagnosis, treatment and prognosis of ANE. Becoming familiarized with this rare but devastating disease will improve detection, treatment, and ultimately prognosis, especially in the era of a new pandemic.

Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241217
Author(s):  
Claudio Tirso Acevedo ◽  
Frank Imkamp ◽  
Ewerton Marques Maggio ◽  
Silvio Daniel Brugger
Keyword(s):  
Head And Neck ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Rrna Gene ◽  
Gene Sequence Analysis ◽  
Rare Manifestation ◽  
Life Threatening ◽  
Amoxicillin Clavulanic Acid ◽  
Disseminated Nocardiosis ◽  
The Right

Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis. The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.

scholarly journals Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male

2016 ◽  
Vol 8 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Nabeel Badri ◽  
Mohamed Teleb ◽  
Saad Syed ◽  
Miraie Wardi ◽  
Mateo Porres-Aguilar ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Brain Mri ◽  
Sudden Onset ◽  
Interesting Case ◽  
Imaging Studies ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Hispanic Male

Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.

Multiple cortical brain abscesses due toListeria monocytogenesin an immunocompetent patient

2017 ◽  
Vol 48 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Sadia Khan ◽  
Anil Kumar ◽  
Satyajit Kale ◽  
Nitin Kurkure ◽  
Gulsiv Nair ◽  
...  
Keyword(s):  
Immunocompetent Patient ◽  
Brain Abscesses

scholarly journals Photo Quiz: Frontal Brain Abscesses in an Immunocompetent Patient

2016 ◽  
Vol 54 (9) ◽  
pp. 2215-2215
Author(s):  
James Walter Snyder ◽  
Bradley Gibson
Keyword(s):  
Immunocompetent Patient ◽  
Frontal Brain ◽  
Brain Abscesses

scholarly journals A case report of an immunocompetent patient with Coccidioides meningoencephalitis with atypical brain magnetic resonance imaging findings during a 1 year follow-up

2019 ◽  
Vol 7 (28) ◽  
pp. 33-37
Author(s):  
Dongkwan Jin ◽  
Juliana Gomez
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Image ◽  
Brain Magnetic Resonance Imaging ◽  
Immunocompetent Patient ◽  
Antifungal Drugs ◽  
Resonance Imaging ◽  
Meningeal Enhancement ◽  
Brain Magnetic Resonance Image ◽  
One Year

Coccidioides meningoencephalitis is a central nervous system (CNS) fungal infection withCoccidioides species which can lead to various CNS complications, such as hydrocephalus,vasculitis, and stroke. Most cases reported with Coccidioides meningoencephalitis were inimmunocompromised patients, and the radiologic characteristics on this condition are not wellestablished. Here we report a case of Coccidioides meningoencephalitis in an immunocompetentpatient with one-year follow-up brain magnetic resonance image (MRI) studies after successfultreatment with antifungal drugs. The MRI demonstrated subcortical parenchymal lesions,selectively involving the white matter, and persistent meningeal enhancement.

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