Successful treatment of multifoci nocardial brain abscesses: a case report and literature review

Abstract

Brain nocardiosis is a serious opportunistic infection with high mortality. It exists more common in the immunocompromised hosts than the immunocompetent patients. Trimethoprim-sulfamethoxazole (TMP-SMZ) has been mostly considered as the choice of the medical treatment. Linezolid is also newly found to be effective to avoid the invasive surgery. The authors reported a case of patient with multifoci nocardial brain abscesses who failed with the combination of linezolid and TMP-SMZ alone but recovered with the surgery intervention and sequential antibiotics for 2 years. The patient lived a high quality life without recurrence and complications during the 30 months follow-up.Through the literature review, we recommend earlier stereotactic aspiration for diagnosis, combination with surgery intervention and prolonged anti-infection therapy would improve the prognosis.

FIGURE 1

MRI found multifoci nocardial brain abscesses. (A) Axial T1-weighted image showed multiple low signal intensity lesions. (B) T2 weighting showed significant edema around the lesions. (C, D) T1-weighted contrast-enhanced image showed multifoci, ring-enhancing abscesses.

FIGURE 2

(A) T1-weighted contrast-enhanced image showed the lesion where stereotactic aspiration was done was obviously shrunk (arrow), other lesions were enlarged; (B) 4 weeks after linezolid used, the follow-up image showed the multifoci abscesses slightly shrunk; (C) 6-month follow-up image showed residual lesions on left frontal and right parietal lobe. (D) 12-month follow-up image showed a minor residual lesion on right parietal lobe. (E, F) Axial and coronal 30-month follow-up image did not demonstrate any enhancement of a residual mass.