SHM Converge Scientific Abstract ePoster Gallery-Nocardia Brain Abscess in an Immunocompetent Patient

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A 51-year-old man with hypertension, hyperlipidemia, and alcohol use disorder presented with several weeks of mild headache followed by acute confusion, speech difficulty, and a generalized seizure in the emergency department. He was afebrile and had no leukocytosis or elevated procalcitonin, but exam showed right pronator drift and subtle right-sided weakness. Brain MRI revealed two well-circumscribed lesions with restricted diffusion in the left parietal and right occipital lobes, with surrounding vasogenic edema and mass effect, concerning for cerebral abscesses.<br /><br />He underwent stereotactic aspiration, was started empirically on vancomycin, metronidazole, and cefepime, and then required partial left parietal craniotomy with abscess drainage and washout. Culture from the abscess grew Nocardia paucivorans, and antibiotics were narrowed to trimethoprim-sulfamethoxazole (TMP-SMX) plus ceftriaxone.<br /><br />This case highlights that Nocardia, a gram-positive organism typically associated with pulmonary infection, can rarely cause central nervous system disease and brain abscess even in immunocompetent patients. Although most nocardial infections occur in immunocompromised hosts, alcoholism is a recognized risk factor. Infection usually occurs through inhalation or skin inoculation with hematogenous spread.<br /><br />Management of nocardial brain abscess often requires both neurosurgical drainage and prolonged antimicrobial therapy. TMP-SMX is the standard treatment because of good CNS penetration, but combination therapy is often used because resistance patterns can vary.

Asset Subtitle

Ethan M. Fan

Meta Tag

Author List Ethan M. Fan, Subhan Tabba, Tapan Patel

Category Clinical Vignettes

Concept Nocardia paucivorans

Concept Cerebral Abscess

Concept Trimethoprim-sulfamethoxazole

Concept Central nervous system nocardiosis

Concept Antimicrobial Therapy

Distinguished Non-Finalist

Presenter Organization Texas Health Presbyterian

Presenting Author Ethan M. Fan

Track Adult

Keywords

Nocardia paucivorans

brain abscess

cerebral abscess

central nervous system infection

trimethoprim-sulfamethoxazole

stereotactic aspiration

craniotomy

alcohol use disorder

restricted diffusion MRI

immunocompetent patient

Nocardia paucivorans

Cerebral Abscess

Trimethoprim-sulfamethoxazole

Central nervous system nocardiosis

Antimicrobial Therapy