Nocardia Infection of the Central Nervous System in an Immunocompetent Patient

Abstract

Introduction: Nocardia is typically considered an opportunistic
agent, causing disease in immunodepressed patients. Systemic
Nocardia infection in a majority of the cases begins as a primary
respiratory or cutaneous infection that can complicate with disseminated disease involving the central nervous system (CNS).
Less than 10% of all cases of Nocardiosis result from primary
CNS infection, and even more unusual is Nocardia infection in
immunocompetent patients.
Objective: This article presents a rare case of CNS Nocardia
infection followed by systemic disease in a previously healthy patient.
Results: Male patient, an agricultural engineer, admitted to the
Emergency Room (ER) with fever, coughing, sputum and shortness of breath. During the previous year, the patient was diagnosed with Nocardia brain abscess. He was treated surgically
with excision of the lesion, as well as with antibiotics and systemic corticosteroids to reduce brain swelling. During this visit to
the ER, on physical examination, the patient presented difficulty
breathing and bilateral rhonchi on lung auscultation. Blood work
indicated presences of inflammation; however, chest x-ray did
not show any recent lesions. During his hospital stay, the patient continued to worsen. Bronchoscopy was performed and on
bronchoalveolar lavage multi-resistant Nocardia was identified.
Though correct measures were applied, the patient presented
with respiratory exhaustion, eventually necessitating mechanical
ventilation. Ultimately, the patient died after 124 days of hospital
admission.
Conclusion: Nocardia, a ubiquitous bacteria, rarely causes infection in healthy individuals. This clinical case illustrates a rare
example of primary CNS Nocardia infection with secondary systemic involvement.