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

Abstract

BackgroundNocardia 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.MethodsWe present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).ResultsA 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.ConclusionNB 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.

Multiple Brain Abscesses Caused by Nocardia Beijingensis in a Patient With HIV Infection

“…There have been reports of Nocardia beijingensis infection in HIV-positive patients from the United States [13] and Thailand [7] including in immunocompetent patients from Japan and Colombia [8,9]. There are reports of central nervous system infections caused by Nocardia beijingensis, mainly in male patients between 45 and 71 years of age with various comorbidities such as HIV infection, kidney transplant, diabetes mellitus, and even immunocompetent patients [7][8][9][10][13][14][15]. In those reports, the CNS was the primary source in four cases [8,9,13,14].…”

Stroke like presentation of disseminated CNS Nocardia beijingensis infection in an immunocompetent patient: Case report and review of the literature

“…This was followed by additional reports of pulmonary Nocardiosis [ [15] , [16] , [17] , [18] ] and one case of scleritis in immunocompetent hosts [ 19 ]. The first case reports of CNS involvement in immunocompetent patients were reported in 2019 and again in 2020 [ [20] , [21] , [22] , [23] , [24] ]. Table 2 summarizes reported cases of N. beijingensis in immunocompetent patients.…”

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

“…[6][7][8][9][10] The most recent report by Chauhan, in 2019, was the only case in the United States that involved the CNS. 9 Ours is the second reported case of CNS nocardiosis in the United States, and the first with multiple simultaneous manifestations of disseminated nocardiosis. Our immunocompetent patient developed primary pulmonary disease, which spread to the subcutaneous tissue overlying his sternum and to his brain.…”