Disseminated Nocardia infection with a lesion occupying the intracranial space complicated with coma: a case report

Abstract

Background Disseminated Nocardia infection is a disease that is easily overlooked in patients with lesions occupying the intracranial space complicated with coma. Early diagnosis and treatment are crucial. Case presentation A 65-year-old man was admitted to the First Affiliated Hospital of Zhejiang University in October 2018 with weakness in the right limbs for 3 days and altered consciousness for 1 day. Five months earlier, he had been diagnosed with membranous kidney disease and had received cyclophosphamide and prednisone. At admission, the white blood cell count was 1.37 × 1010/L (with 86.4% neutrophils), and C-reactive protein was 115.60 mg/L. Imaging examinations revealed a lesion occupying the intracranial space, lung infection, and multiple abscesses in the rhomboid muscle. The abscesses were drained. Pus culture confirmed Nocardia cyriacigeorgica infection. With antibiotics and vacuum-sealed drainage of the back wound, the patient improved and was discharged from the hospital. Conclusions This case report shows that infection should be considered during the differential diagnosis of lesions in the intracranial space, especially in patients receiving immunosuppressive treatment. In patients with disseminated N. cyriacigeorgica infection, combination antibiotic therapy and surgical drainage of localised abscesses can be effective.

Cryptogenic Organizing Pneumonia Complicated With Cutaneous Disseminated Nocardia Infection: A Case Report and Literature Review

“…In the diagnosis and treatment of Nocardia, the spread of Nocardia affects at least two adjacent organs, especially brain abscess, which is an important factor in the adverse outcome of patients. We searched relevant literature from 2017 to 2021 in PubMed and Web of Science using disseminated Nocardia infection and case reports as the keywords and included confirmed disseminated Nocardia infection involving 2 organs and the above, complete records of adult cases, a total of 126 cases of disseminated Nocardia infection were retrieved, a total of 23 cases were included in the study (13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), and the remaining 113 cases (58 cases involving less than 2 organs, 23 cases with disease course records incomplete, 12 cases with other infections, 11 cases with no confirmed Nocardia infection, 4 cases where the full text could not be found, and 5 cases reported non-human or adult cases) were excluded. A summary and review of the 23 cases are presented below (Table 3).…”

Research Progress in the Treatment of Complications and Sequelae of COVID-19

“…However, patients with hypertension may need to switch to calcium channel blockers (CCB) and diuretics ( 35 ). In addition, the patients with intracranial infections should be treated in terms of the principles of diagnosis and treatment of intracranial infection, protecting against dehydration, controlling seizures and providing antipsychotic treatment ( 36 ). In addition, sufficient attention and symptomatic treatment should be given for complication secondary to nerve damage, such as abnormalities of the skeletal muscle, glands and internal organs.…”