Nocardia intracranial mycotic aneurysm associated with proteasome inhibitor

Abstract

We report a case of Nocardia farcinica ruptured intracranial mycotic aneurysm associated with bortezomib and corticosteroid treatment in a multiple myeloma patient. The patient was treated with trimethoprim-sulfamethoxazole and moxifloxacin together with surgical repairment of intracranial mycotic aneurysm.

Keywords: Multiple myeloma; Mycotic aneurysm; Nocardia; Nocardia farcinica; Proteasome inhibitor.

Fig. 1

(A) Computed tomography of the brain with contrast showed multiple small rim-enhancing lesions with marked perilesional vasogenic edema scattered at the gray and white junction of the bilateral cerebral hemisphere. (B) Computed tomography angiography of the brain showed a lobulated saccular outpouching lesion arising from the anterior branch at M2 segment of the left middle carotid artery (red arrow). (C) A modified acid-fast staining of the pus from the right chest wall showed beaded filamentous branching organisms with few white blood cells. (D) Gram’s staining of thrombus inside the aneurysm showed few clusters of Gram-positive filamentous bacilli (arrow).