A Case of Nocardia farcinica Brain Abscess in the Patient Receiving Steroid Treatment

Sung Hoon Sim; Hayne Cho Park; Chung-Jong Kim; Jae Hyun Jeon; Eui-Chong Kim; Myoung-don Oh; Nam-Joong Kim; Kang-Won Choe

doi:10.3947/ic.2008.40.5.301

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Sim, Park, Kim, Jeon, Kim, Oh, Kim, and Choe: A Case of Nocardia farcinica Brain Abscess in the Patient Receiving Steroid Treatment

Case Report

Infection and Chemotherapy

Infection and Chemotherapy 2008; 40(5): 301-304.

Published online: 25 October 2008

DOI: https://doi.org/10.3947/ic.2008.40.5.301

A Case of Nocardia farcinica Brain Abscess in the Patient Receiving Steroid Treatment

Sung Hoon Sim, M.D.¹, Hayne Cho Park, M.D.¹, Chung-Jong Kim, M.D.¹, Jae Hyun Jeon, M.D.¹, Eui-Chong Kim, M.D., Ph.D.², Myoung-don Oh, M.D., Ph.D.¹, Nam-Joong Kim, M.D., Ph.D.¹, Kang-Won Choe, M.D., Ph.D.¹

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

²Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence: Nam-Joong Kim, M.D. Division of Infectious Disease, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Korea. Tel: +82-2-2072-2228, Fax: +82-2-762-9662, molder@uniter.co.kr

Received 27 June 2008 Accepted 4 August 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nocardiosis occurs mostly in the immunocompromised patients. N. farcinica is known to have resistance to some antibiotics and significant increase in morbidity and mortality in patients requiring long-term treatment. Nocardia farcinica infection, especially brain abscess, has not been reported in Korea. Here, we report a case of N. farcinica brain abscess in a patient receiving steroid treatment. The patient was a 64 year-old male with gouty arthritis. He received steroid for more than two months, because of allopurinol-hypersensitivity syndrome with skin rash. After three months of steroid therapy, he visited other hospital with mild fever and left thigh pain and was diagnosed of intramuscular abscess due to gram positive bacilli. One month later, he visited our hospital with right side weakness and was diagnosed as brain abscess. The causative organism turned out to be N. farcinica, which was confirmed by means of 16S rRNA sequencing. Antibiotics were selected by E-test results and treatment was successful

Keywords: Nocardia farcinica, Brain abscess, Steroids, Immunocompromised host

Figures and Tables

Figure 1

Brain MRI of the patient. Ill-defined mass lesions are observed with mulitple rim enhancement, central necrosis and perilesional edema in left thalamus. (A) Axial gadolinium-enhanced T1-weighted image. (B) Coronal gadolinium-enhanced T1-weighted image.

Figure 2

Gross picture of cultured colonies of aspirated material and Gram stain of cultured colonies. (A) Yellowish, round colonies are found. (B) Gram-positive branched rods are observed (×200).

Figure 3

E-test of amikacin and trimethoprim-sulfamethoxazole. MIC was 0.5 µg/mL (S) in amikacin, 0.75 µg/mL (S) in trimethoprime-sulfamethoxazole.

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