Nocardia abscessus-related intracranial aneurysm of the internal carotid artery with associated brain abscess: A case report and review of the literature

Abstract

Nocardia infections primarily begin in the lungs and spread hematogenously to other sites in the body. Thus, a Nocardia brain abscess is not a completely uncommon occurrence. However, a Nocardia brain abscess complicated by a middle cerebral artery and infectious intracranial aneurysm is a very rare clinical entity. We present a case of an infectious intracranial aneurysm with an associated Nocardia brain abscess that required surgical intervention and resection. The patient was an immunocompetent 60-year-old male who presented with a chief complaint of headache and was found to have an infected intracranial aneurysm and cerebral abscess. He underwent drainage of the abscess with subsequent resection of the infected aneurysm. Cultures from both the blood vessel and brain tissue grew Nocardia abscessus. He was successfully treated with 6 weeks of ceftriaxone and high-dose trimethoprim-sulfamethoxazole. Infectious intracranial aneurysms of the brain caused by Nocardia are rare occurrences, and only a single previous case has been described in the literature. The outcomes of this condition can be catastrophic if it is not treated with a combination of surgery and intravenous antibiotics. The guidelines for the management of this infection are not well defined at this time.

Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

“…[39][40][41][42][43][44] To our knowledge, N. abscessus brain abscess in an immunocompetent host has been reported five times in the literature. [10,13,[45][46][47] In this report we present a sixth case of cerebral abscess by N. abscessus in an immunocompetent patient.…”

“…Mortality from N. abscessus is reported to be as high as 31%-34.6% but this reported mortality was in infected immunocompromised patients. [46,48] There is no reported mor-tality in the five reported cases of brain abscess caused by N. abscessus pathogen in the immunocompetent patients. [10,13,[45][46][47] Two of the cases were treated solely by antibiotic.…”

Nocardia spp.: A Rare Cause of Pneumonia Globally

“…179,181 Antimicrobial therapy may be curative, 181 but mortality rates are high (may exceed 40%). In some cases, surgical debridement, drainage, or resection of brain abscesses may be necessary, [182][183][184][185] particularly in those with impaired immunity. 34,175 In one IC patient with brain abscesses and an intracranial aneurysm due to N. abscessus, a combination of antimicrobials and surgical resection of the aneurysm was curative.…”

“…34,175 In one IC patient with brain abscesses and an intracranial aneurysm due to N. abscessus, a combination of antimicrobials and surgical resection of the aneurysm was curative. 183 Severe CNS disease may occur even in previously healthy children 9 and adults. 38,183,186,187 Nocardia paucivorans, which rarely causes diseases in humans, appears to have a predilection for CNS involvement and dissemination.…”

“…183 Severe CNS disease may occur even in previously healthy children 9 and adults. 38,183,186,187 Nocardia paucivorans, which rarely causes diseases in humans, appears to have a predilection for CNS involvement and dissemination. 38,184,188 Similarly, N. asiatica 33 and N. farcinica have a proclivity for CNS involvement.…”