Nocardia cyriacigeorgica brain abscess in a patient on low dose steroids: a case report and review of the literature

BMC Infect Dis. 2022 Jul 21;22(1):635. doi: 10.1186/s12879-022-07612-y.

Abstract

Background: Nocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids.

Case presentation: A 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae.

Conclusions: Nocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.

Keywords: Brain abscess; Case report; Immunocompetent; N. cyriacigeorgica.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Brain Abscess* / diagnosis
  • Brain Abscess* / drug therapy
  • Brain Abscess* / surgery
  • Humans
  • Male
  • Nocardia Infections* / complications
  • Nocardia Infections* / diagnosis
  • Nocardia Infections* / drug therapy
  • Nocardia*
  • Steroids / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Steroids

Supplementary concepts

  • Nocardia cyriacigeorgica