Solitary Spinal Intramedullary Abscess Caused by Nocardia asteroides

Disseminated Cerebral and Intradural Extramedullary Spinal Nocardiosis in an Immunocompetent Patient

“…Nocardial involvement of the CNS, in particular the spinal cord and meningeal layers, is exceedingly rare with only a handful of tissue and culture-confirmed cases in the literature [9][10][11][12][13][14][15] . We searched the literature for nocardia infection of the spinal cord and the spinal meninges and summarize the location, therapy and follow-up results in Table 1.…”

“…We searched the literature for nocardia infection of the spinal cord and the spinal meninges and summarize the location, therapy and follow-up results in Table 1. Nocardial involvement of the spinal cord occurs predominately in the immunocompromised population [7,9,10,[13][14][15] with only one case of an isolated spinal cord intramedullary nocardial abscess in an immunocompetent patient [12] ; however, there no evidence that formal immune testing was performed [8,11] . In the majority of cases, there was a co-existing pulmonary nocardial infective focus which was likely to represent the primary site prior to CNS dissemination [9,11,13,14] .…”

“…In the majority of cases, there was a co-existing pulmonary nocardial infective focus which was likely to represent the primary site prior to CNS dissemination [9,11,13,14] . However, isolated spinal cord nocardial abscesses without extra spinal involvement [12] or nocardial CNS abscesses have been reported [10,15] . Our case was interesting in that the patient had known cerebral involvement before the development of the intradural focus, raising the possibility of CSF spread from the intracerebral focus.…”

“…Our case was interesting in that the patient had known cerebral involvement before the development of the intradural focus, raising the possibility of CSF spread from the intracerebral focus. Spinal cord nocardial infection must be diagnosed extremely quickly as the majority of patients present with rapid evolving focal neurological symptoms, which if not treated in a timely manner can result in permanent neurological impairment [9][10][11][12][13][14][15] . Stokes et al reported both urinary frequency and incontinence in lesions involving the cervical spine and conus medullaris, causing a partial cauda equina syndrome without perianal anaesthesia as an associated symptom [14] .…”

“…Penicillin, chloramphenicol, oxacillin, metronidazole, ceftriaxone, fluconazole, amikacin, cotrimoxazole Mukunda et al [12] 52; M Isolated intramedullary abscess Intramedullary focus Nocardia asteroides, intraspinal focus…”