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Case Report
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| Intramedullary spinal cord abscess by Nocardia: A case report | ||||||
| Khaled Alshabani1, Joseph Adrian L. Buensalido2, Milagros P. Reyes3, Ayman O. Soubani4 | ||||||
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1MD, Wayne State University, Department of Internal Medicine, Detroit, MI, USA.
2MD, Wayne State University, Department of Internal Medicine, Division of Infectious Diseases, Current affiliation: University of the Philippines - Philippine General Hospital, Section of Infectious Diseases, Manila, Philippines. 3MD, FACP, FIDSA, Professor of Medicine, Wayne State University, Department of Internal Medicine, Division of Infectious Diseases, Detroit, MI, USA. 4MD, Professor of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Detroit, MI, USA. | ||||||
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| How to cite this article |
| Alshabani K, Buensalido JAL, Reyes MP, Soubani AO. Intramedullary spinal cord abscess by Nocardia: A case report. Int J Case Rep Images 2015;6(7):448–453. |
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Abstract
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Introduction:
Nocardia is a Gram-positive bacteria that usually cause opportunistic infections but can affect the immunocompetent host. The central nervous system can be the primary site of infection in up to 40% of the cases but the involvement of the spinal cord is extremely rare.
Case Report: We present a case of a middle age man with history of alcoholic liver cirrhosis and diabetes mellitus who presented with acute lower back pain that is associated with right leg weakness and numbness. Magnetic resonance imaging (MRI) scan showed a spinal cord intramedullary abscess. The cerebrospinal fluid analysis was consistent with meningitis and the organism was eventually identified with CSF culture as Nocardia Farcinica. Patient was treated with prolonged intravenous trimethoprim/sulfamethoxazole and meropenem. No neurosurgical intervention was done and the patient had full neurological recovery in few months. Discussion: Nocardia species are able to cause different kinds of disease in man. Spinal cord abscess are extremely rare and high index of clinic suspicion is required for diagnosis. Initial combination intravenous antibiotics treatment is essential and should be continued for at least three to six weeks. Treatment can be switched to oral and continued for a minimum of six months. Surgical intervention might be indicated in some patients. 16s rRNA gene sequencing allows earlier identification and thus adjustment of antibiotics. Conclusion: This report illustrates that a diagnosis can be made by neuroimaging and cerebrospinal fluid (CSF) 16s ribosomal RNA sequencing, allowing early and effective antibiotic therapy and obviating the need for a high-risk neurosurgical intervention. | |
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Keywords:
Gram-positive bacteria, Intramedullary abscess, Nocardia, Spinal cord
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Author Contributions
Khaled Alshabani – Substantial contributions to conception and design, Acquisition of date, Analysis and interpretation of date, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Joseph Adrian L. Buensalido – Substantial contributions to conception and design, Acquisition of date, analysis and interpretation of date, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Milagros P. Reyes – Substantial contributions to conception and design, Analysis and interpretation of date, Revising the article critically for important intellectual content, Final approval of the version to be published Ayman O. Soubani – Substantial contributions to conception and design, Analysis and interpretation of date, Revising the article critically for important intellectual content, 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
© 2015 Khaled Alshabani et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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