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Case Reports
. 2020 Oct 19;15(4):1072-1075.
doi: 10.4103/ajns.AJNS_283_20. eCollection 2020 Oct-Dec.

Ruptured Mycotic Cerebral Aneurysm Secondary to Disseminated Nocardiosis

Masayuki Goto  1 , Aiki Marushima  1 , Kyoji Tsuda  1 , Tomoji Takigawa  1 , Wataro Tsuruta  1 , Eiichi Ishikawa  1 , Yuji Matsumaru  1 , Akira Matsumura  1
Affiliations
Case Reports

Ruptured Mycotic Cerebral Aneurysm Secondary to Disseminated Nocardiosis

Masayuki Goto et al. Asian J Neurosurg. .

Abstract

We report a case of a ruptured mycotic cerebral aneurysm caused by Nocardia infection. A 22-year-old immunocompromised woman with adult-onset Still's disease developed a subarachnoid hemorrhage (SAH). Digital subtraction angiography revealed a small aneurysm at the M2-3 bifurcation of the right middle cerebral artery. Cardiac ultrasonography showed vegetation at the posterior cardiac wall, suspecting infective endocarditis (IE). Gram-positive filamentous bacteria were observed in the necrotic tissue surrounding the aneurysm obtained during trapping surgery. Long-term blood culture showed that the cause of her cerebral mycotic aneurysm was nocardiosis. A mycotic ruptured cerebral aneurysm is an important cause of SAH in immunocompromised patients. Early diagnosis of IE, detection of gram-positive rods by Gram staining, and long-term culture to identify the bacteria is crucial in diagnosing nocardiosis.

Keywords: Immunosuppressed host; nocardiosis; ruptured mycotic cerebral aneurysm.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Head computed tomography scan at the onset of subarachnoid hemorrhage demonstrates diffuse subarachnoid hemorrhage with intracranial hematoma
Figure 2
Figure 2
Digital subtraction angiography at the onset of subarachnoid hemorrhage demonstrates a small aneurysm at the right M2-3 bifurcation (red arrow). (a) Anteroposterior view, (b) Lateral view, (c) 3D Rotational Angiography
Figure 3
Figure 3
Clinical and pathological findings of aneurysm (a) The aneurysm filled with pus, which leaked out from the point of destruction of the aneurysm wall (*). The aneurysm wall appears white and turbid with irregularities (b) Pathological analysis demonstrates an internal elastic lamina (arrow head), intravascular lumen (*), expanded media (**), destruction of internal elastic lamina (arrow), and persisting outer membrane (double arrows) (c and d) Gram-positive filamentous bacteria detected in the necrosis surrounding the aneurysm
See this image and copyright information in PMC

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