Diffuse Nocardial Spinal Subdural Empyema: Diagnostic Dilemma and Treatment Options

Aljuboori, Zaid; Sharma, Mayur; Altstadt, Thomas

doi:10.7759/cureus.1795

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Subsequent symptoms occur in the nervous system. Common imaging manifestations include brain abscess, granuloma formation or fusion swelling, meningitis, and epidural and paravertebral abscesses [15][16][17][18]. Both cases had typical brain imaging ndings.…”

Section: Discussionmentioning

confidence: 99%

Patients with rheumatic immune diseases on immunosuppressants who died of Nocardia farcinica infection - case report

Han

Huang

Yang

et al. 2023

Preprint

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Background: Nocardiosis is a rare suppurative infectious disease caused by Nocardia, a gram-positive filamentous bacterium that is widely distributed in air, water, soil and other media. It usually occurs in patients treated with immunosuppressants but can also occur in healthy people. The aim of this study was to describe the course of two patients with rheumatic immune diseases who died of pneumonia and brain, renal, liver abscesses and sepsis caused by Nocardia farcinica infection. Case presentation: A 74-year-old retired male, diagnosed with dermatomyositis (DM), and a 54-year-old female farmer, diagnosed with systemic lupus erythematosus (SLE), both taking glucocorticoids and immunosuppressants, suffered from pneumonia and brain, renal, and liver abscesses and sepsis caused by Nocardia farcinica. Their medical treatment processes were very complicated, and they underwent multiple examinations and multidisciplinary consultations. They were finally diagnosed with pneumonia, brain, renal, and liver abscesses and sepsis caused by Nocardia farcinica infection through blood, sputum and bronchoalveolar lavage fluid culture. They were treated with antibacterial drugs, but the course was insufficient because of economic reasons, and eventually, they died. Conclusions: Nocardia farcinica is a rare but possible cause of pneumonia or brain, renal, liver abscesses or sepsis inpatients with rheumatic immune diseases. If infection is not ruled out in the lungs or other organs, it is necessary to actively utilise a variety of pathogenic tests, including blood culture. Once patients with immunosuppressive agents get pneumonia, brain abscesses, renal abscesses, liver abscesses or sepsis caused by Nocardia farcinica, they are in a critical condition and easily die.

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Section: Discussionmentioning

confidence: 99%

Patients with rheumatic immune diseases on immunosuppressants who died of Nocardia farcinica infection - case report

Han

Huang

Yang

et al. 2023

Preprint

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“…Our case is consistent with this pattern, that is multiple cavities occurring and changing over a short period of time. The next is the nervous system, common imaging findings include brain abscess, granulomatous formation or diffuse infiltration [ 16 , 17 ], meningitis, epidural and paraspinal abscesses [ 18 , 19 ]. This case has no typical brain MRI performance.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature

Zhang

et al. 2021

BMC Infect Dis

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Background Nocardia is a relatively rare opportunistic pathogenic bacteria group, commonly seen in patients with immunocompromised or defective immune system. It can affect multiple organs of the body and cause disseminated infection, among which most occurs in the lung, secondly in the nervous system, soft tissues, rare in the spinal cord and pituitary. No case has been reported involving lung, spinal cord, skin and pituitary gland at the same time. Case presentation We report a 55-year-old female with Nocardia infection involving the lung, skin, spinal cord, and pituitary gland. The patient underwent a full set of imaging examinations and showed typical imaging findings. Chest computed tomography (CT) showed multiple nodules with cavities in the lungs. The magnetic resonance imaging (MRI) of the vertebral body showed abnormal signal of the entire spinal cord with cavity formation and ring enhancement. The subcutaneous nodules of the abdomen were punctured under ultrasound. Through the etiological tissue culture of subcutaneous nodules and the second generation sequencing of cerebrospinal fluid, the diagnosis was finally confirmed. Conclusion Disseminated Nocardiosis is an uncommon disease. This article will report a rare case of disseminated Nocardiosis simultaneously involving the lung, spinal cord, subcutaneous soft tissue and pituitary gland, especially with neuropathy as the initial symptom. Imaging is helpful for the early diagnosis of the disease and pathological and microbiological examinations are helpful for its confirming.

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“…fungal, mycobacterial, nocardial, and Brucella species are identified in rare cases involving patients with intravenous drug abuse. 1,3,7,11,15 Prolonged antibiotic therapy, for at least 6-8 weeks if the infection is bacterial or lifelong if it is fungal or mycobacterial, is indicated in these patients. However, despite aggressive treatment, relapse of infection and patient death have been reported in up to 32% and 6%-15% of cases, respectively.…”

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confidence: 99%

Insights into complication rates, reoperation rates, and healthcare utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections

Sharma

Dietz

Alhourani

et al. 2019

Neurosurgical Focus

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OBJECTIVEUse of recombinant human bone morphogenetic protein–2 (rhBMP-2) in patients with spine infections is controversial. The purpose of this study was to identify long-term complications, reoperations, and healthcare utilization associated with rhBMP-2 use in patients with spine infections.METHODSThis retrospective study extracted data using ICD-9/10 and CPT codes from MarketScan (2000–2016). Patients were dichotomized into 2 groups (rhBMP-2, no rhBMP-2) based on whether rhBMP-2 was used during fusion surgery for spinal infections. Outcomes of interest were reoperation rates (index level, other levels), readmission rates, discharge disposition, length of stay, complications, and healthcare resource utilization at the index hospitalization and 1, 3, 6, 12, and 24 months following discharge. Outcomes were compared using nonparametric 2-group tests and generalized linear regression models.RESULTSThe database search identified 2762 patients with > 24 months’ follow-up; rhBMP-2 was used in 8.4% of their cases. The patients’ median age was 53 years, 52.43% were female, and 15.11% had an Elixhauser Comorbidity Index ≥ 3. Patients in the rhBMP-2 group had higher comorbidity indices, incurred higher costs at index hospitalization, were discharged home in most cases, and had lower complication rates than those in the no–rhBMP-2 group. There was no statistically significant between-groups difference in complication rates 1 month following discharge or in reoperation rates at 3, 6, 12, and 24 months following the procedure. Patients in the no–rhBMP-2 group incurred higher utilization of outpatient services and medication refill costs at 1, 3, 6, 12, and 24 months following surgery.CONCLUSIONSIn patients undergoing surgery for spine infection, rhBMP-2 use was associated with lower complication rates and higher median payments during index hospitalization compared to cases in which rhBMP-2 was not used. There was no significant between-groups difference in reoperation rates (index and other levels) at 3, 6, 12, and 24 months after the index operation. Patients treated with rhBMP-2 incurred lower utilization of outpatient services and overall payments. These results indicate that rhBMP-2 can be used safely in patients with spine infections with cost-effective utilization of healthcare resources and without an increase in complications or reoperation rates.

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Diffuse Nocardial Spinal Subdural Empyema: Diagnostic Dilemma and Treatment Options

Cited by 4 publications

References 9 publications

Patients with rheumatic immune diseases on immunosuppressants who died of Nocardia farcinica infection - case report

Patients with rheumatic immune diseases on immunosuppressants who died of Nocardia farcinica infection - case report

Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature

Insights into complication rates, reoperation rates, and healthcare utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections

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