"Primary" nocardial brain abscess in a renal transplant patient

Ranga Migara Weerakkody,Eranga Sanjeewa Wijewikrama,Saman Wadanambi,Dhammika Randula Palangasinghe

doi:10.1186/s13104-015-1697-4

Ranga Migara Weerakkody, Eranga Sanjeewa Wijewikrama + Show 2 more

Open Access

https://doi.org/10.1186/s13104-015-1697-4

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Abstract

BackgroundIntracranial abscesses are rare among transplant recipients, and Nocardia is responsible for less than 2 % of them. Nocardiosis, a chronic infection and is difficult to treat. Primary infection involves lungs and eventually disseminates. Primary nocardial abscesses are rare and we report a case from Sri Lanka.Case presentationA 38 year old Sri Lankan, who has received his 2nd ABO matched live donor transplantation, which was complicated with perinephric hematoma and massive transfusion syndrome. He presented with fever, worsening headache and papilledema. An urgent magnetic resonance image (MRI) showed an occipital abscess with midline shift. Craniotomy and drainage followed by 3 week course of imipenem and levofloxacin, which rendered him symptom free. After 12 months he has stayed recurrence free. Imaging and bacteriology of the respiratory tract failed to demonstrate Nocardia infection.ConclusionIsolated (Primary) nocardial brain abscess are rare, and have an excellent response to medical therapy. We achieved a good response from a relatively short course of antibiotics (not using sulfonamides, due to allergy), where long courses of antibiotic had been the norm.

Highlights

Intracranial abscesses are rare among transplant recipients, and Nocardia is responsible for less than 2 % of them
Cerebral abscess are rare among the renal transplant (RT) patients with an incidence of 3.6 per 1000 cases/year [1]
Partially acid fast, and filamentous bacilli found in soil [3]

Summary

Conclusion

Primary nocardial cerebral abscess is rare in transplanted patients and has a very good prognosis compared to disseminated disease. Long courses of antibiotics are recommended, but this case shows complete recovery is possible with even 3 weeks of antibiotics, provided the abscesses could be successfully drained. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Authors’ contributions RMW and ESW have done the nephrological management of the patient while SW has performed neurosurgery and had neurosurgical input for the manuscript. RW and DRP have written and revised the manuscript, while ESW has critically analyzed it. Author details 1 University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 9, Sri Lanka. 2 Department of Neurosurgery, National Hospital of Sri Lanka, Regent Street, Colombo 9, Sri Lanka.

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