Brain Abscess Due To Asian Nocardia in a 63 Years-Old Patient with Adult Still´S Disease: A Rare Case Report and Literature Review

Cerebral nocardiosis is a rare and opportunistic pathology caused by a gram-positive, aerobic bacterium of the order of Actinomycetes called Nocardia spp. It appears in patients with immunodeficiencies affecting cellular immunity. Nocardia can affect an organ (lungs in 75% of cases) or manifest itself as a disseminated infection (central nervous system in 25% of cases). Here we present a rare case of 63-years-old patient immunocompromised by monoclonal biologic treatment for Adult-Onset Still disease (AOSD), who subsequently presents fever, signs of motor focality and resonance imaging findings which show supra and infratentorial lesions. The patient is managed in intensive therapy for sensory impairment, receiving standardized antibiotic scheme, getting through to complicated evolution. Cerebral nocardiosis is a rare infectious disease that requires an early diagnostic study and its respective treatment.

Advanced multimodality MR imaging of a cerebral nocardiosis abscess in an immunocompetent patient with a focus on Amide Proton Transfer weighted imaging

Cerebral nocardiosis abscess is a very rare entity in an immunocompetent patient. In this case report multiparametric and multimodality MR imaging characteristics of a pyogenic brain abscess caused by Nocardia Farcinica are discussed with a specific focus on amide proton transfer weighted imaging as a modern non-invasive, molecular MR imaging method which detects endogenous mobile protein and peptide concentration and tissue pH changes in pathologic brain lesions. The imaging characteristics are reviewed and discussed in respect to possible differential diagnoses, especially malignant tumorous lesions.

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

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.

Galvos smegenų nokardiozė: atvejo pristatymas ir literatūros apžvalga Cerebral nocardiosis: case report and literature review

vadas. Smegenų nokardiozė yra ypač reta, oportunistinė galvos smegenų infekcija, sudaranti iki 2 % visų galvos smegenų abscesų atvejų. Šia liga dažniau serga imunosupresuoti pacientai, tačiau yra aprašyta ligos atvejų pacientams su nesutrikusia imuninės sistemos funkcija. Diagnozuoti ligą sudėtinga, kadangi smegenų nokardiozė progresuoja lėtai, nėra tipinių laboratorinių ar klinikinių požymių, o galutinė diagnozė nustatoma tik pooperacinio mikrobiologinio pūlių tyrimo metu. Atvejo pristatymas. Šiame straipsnyje pristatomas 80 m. vyro, sergančio smegenų nokardioze ir neturinčio išreikštos imunosupresijos, atvejis. Nokardiozė nustatyta tik pooperaciniu periodu, atlikus pūlių mikrobiologinio pasėlio tyrimą. Išvados. Smegenų nokardiozės diagnostika yra sudėtinga, o gydymas – agresyvus ir ilgalaikis. Šiuo atveju atlikta radikali pūlinio ekscizija, galimo pirminio odontogeninio židinio sanacija ir ilgalaikė (21 mėn.) antibiotikoterapija „Biseptoliu“ (trimetoprimu ir sulfametoksazoliu), dėl kurios pacientas visiškai pasveiko.

Cerebral Nocardiosis: A Rare Cause of Hemiplegia in the Acute Medicine Unit

Nocardiosis, a rare infection occurring mostly in immunosuppressed patients can present with neurological complications including cerebral abscess formation, and is associated with high morbidity and mortality. We describe the case of a 54-year-old immunocompetent man with cerebral nocardiosis, who presented with sudden onset hemiparesis in an acute medicine unit. He required three craniotomies with excision, following failure to respond to antimicrobial therapy, with subsequent clinical improvement and radiological resolution of multiple cerebral abscesses. Challenges in diagnosis and management of hemiparesis in the acute medical unit are discussed. Successful management of cerebral nocardiosis require early communication with a neurosurgical unit, neuropathology and microbiology services to optimise management with targeted antimicrobial therapy.