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Case Report
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| Multiple nocardial brain abscesses in an immunocompromised patient with myasthenia gravis | ||||||
| Ayesha Shaikh1, Maria Lola Cevallos2, Fang Lan3, Jean Pratt Daniel4 | ||||||
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1PGY1, Internal Medicine Lincoln Medical and Mental Health Center, Bronx, NY, United States.
2Department of Internal Medicine, Lincoln Medical & Mental Health Center, Bronx, NY, United States. 3PGY2 , Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, United States. 4Department of Internal Medicine, Lincoln Medical & Mental Health Center, Bronx, NY, United States. | ||||||
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| How to cite this article: |
| Shaikh A, Cevallos ML, Lan F, Daniel JP. Multiple nocardial brain abscesses in an immunocompromised patient with myasthenia gravis. International Journal of Case Reports and Images 2013;4(1):11–14. |
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Abstract
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Introduction:
Nocardia are gram positive, variably acid-fast positive diphtheroid-like to branched, filamentous, aerobic actinomycetes. Nocardiosis is an opportunistic infection that has been noted in patients with malignancies, systemic lupus erythematosus, HIV infection, hematopoietic stem cell transplant recipients and long-term steroid users.
Case Report: A 32-year-old female presented with history of myasthenia gravis on long-term glucocorticoid therapy. During her last admission, wound culture of her left shoulder abscess showed diptheroid organisms. Patient presented with severe headache, nausea, vomiting and altered mental status. She was initially diagnosed with metastatic cerebral abscess and treated with empiric antimicrobial therapy. Imaging study of the brain showed bilateral occipital ring enhancing lesions. Biopsy results came back as culture positive for nocardia. Patient was subsequently treated with intravenous antibiotics for a total of six months. Conclusion: Cases of nocardiosis may go undiagnosed, either because they respond to empiric antimicrobial treatment or because Nocardia spp. may be difficult to identify in cultures of clinical specimens. They may be mistaken for nonpathogenic microorganisms (diphtheroids) and discarded. High suspicion and early long term institution of therapy are key to a favorable outcome of this disease which has high mortality rates. | |
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Keywords:
Nocardiosis, Brain, Abscess, Steroid use
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Author Contributions:
Ayesha Shaikh – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Maria Lola Cevallos – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Fang Lan – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Jean Pratt Daniel – Conception and design, Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Ayesha Shaikh et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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