SHM Converge Scientific Abstract ePoster Gallery-A Case of Profound Dysgeusia in Disseminated Nocardia

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A 70-year-old man with diabetes developed three months of fatigue, productive cough, anorexia, and weight loss. Chest CT showed a large right upper and middle lobe lung mass, and bronchoscopy cultures grew branching gram-positive bacilli identified as <em>Nocardia abscessus</em> complex. He was started on IV trimethoprim-sulfamethoxazole, but brain MRI revealed two enhancing lesions in the right temporal lobe and cerebellar vermis, indicating disseminated nocardiosis with CNS involvement. Imipenem and amikacin were added.

During treatment, he developed severe progressive dysgeusia, describing that “everything tastes horrible,” along with nausea. The symptoms were initially attributed to amikacin, so therapy was changed to linezolid and supportive antiemetics were given, but the dysgeusia persisted. ENT consultation suggested that the temporal lobe abscess extended into the insular cortex, near the brain’s gustatory center, likely explaining his abnormal taste sensation.

Before discharge, his antibiotics were changed to IV ceftriaxone and high-dose oral TMP-SMX. At one-month follow-up, his dysgeusia had markedly improved, and repeat MRI showed significant reduction in the size of the brain abscesses. TMP-SMX was later stopped because of hyperkalemia, and ceftriaxone was planned for a prolonged course.

This case highlights that nocardiosis can involve the central nervous system and cause unusual neurologic symptoms. It also suggests that dysgeusia may result not only from medications but from brain abscesses affecting the insular cortex and gustatory pathways.

Asset Subtitle

Chanjun Park

Meta Tag

Author List Chanjun Park, Joseph Nicholas, Seif Nasir

Category Clinical Vignettes

Concept Nocardia abscessus complex

Concept Nocardiosis

Concept Central Nervous System Infection

Concept Cerebral Abscess

Concept Pulmonary infection

Distinguished Non-Finalist

Presenter Organization University of Rochester School of Medicine and Dentistry

Presenting Author Chanjun Park

Track Adult

Keywords

nocardiosis

Nocardia abscessus

brain abscess

central nervous system

dysgeusia

insular cortex

trimethoprim-sulfamethoxazole

imipenem

amikacin

disseminated infection

Nocardia abscessus complex

Nocardiosis

Central Nervous System Infection

Cerebral Abscess

Pulmonary infection