Successful Treatment of HIV-Combined CNS Nocardia Terpenica Infection with Cotrimoxazole as a Single Agent During the Maintenance Phase: A Case Report and Review of the Literature

Abstract

The Nocardia infection of the central nervous system (CNS) in HIV-positive individuals is difficult to diagnose and treat, often requiring a combination of at least two drugs during the maintenance phase. In this article, we report a case of CNS Nocardia terpenic infection in an AIDS patient diagnosed by cerebrospinal fluid targeted next-generation sequencing (tNGS), which was ultimately treated successfully with sulfamethoxazole monotherapy due to adverse drug reactions. Additionally, we reviewed the relevant literature to explore individualized treatment options for CNS Nocardia infections in patients with AIDS and to provide clinicians with evidence-based treatment recommendations.

Keywords: AIDS; Nocardia terpenica; case report; central nervous system; tNGS.

Figure 1

Comparison of cranial images before and after treatment in a patient with HIV combined with CNS Nocardia Terpenica infection. (A) January 17, 2023. Abnormal signal in the right frontal lobe, striated enhancement shadows in the suprasellar pool, and enhancement foci in the left parahippocampal gyrus, suggesting infectious lesions (indicated by arrows); (B) August 14, 2023. Intracranial infectious foci were better resorbed than previously imaged; (C) January 16, 2024. Intracranial infectious foci had disappeared; (D) April 13, 2024. The intracranial infected lesion had largely disappeared.

Figure 2

Bone marrow cytology: active proliferation of the granulopoietic lineage; markedly active proliferation of the erythroid lineage, with some megaloblastic changes visible; megakaryocytic lineage not classified, with platelets in small clusters; 1% monocytes visible.