Pulmonary Nocardiosis with Brain Abscess: A Case Report and Literature Review

Abstract

Nocardiosis is an uncommon disease in humans, and is considered an opportunistic infection which characteristically develops in immunocompromised persons. We report a patient with chronic obstructive pulmonary disease (COPD) with acute exacerbation, who had been treated with long-term corticosteroids. About seven days after admission, the patient developed high fever and bilateral pneumonia. Unfortunately, acute respiratory failure and multiple brain abscesses developed during hospitalization. Gram’s staining of deep-suctioned sputum revealed Nocardia species. Empirical antibiotics were then changed to trimethoprim-sulfamethoxazole (TMP-SMZ) and minocycline for pulmonary nocardiosis, and ceftriaxone for brain abscess. The condition of the central nervous system (CNS) still worsened, despite the fact that the pneumonic patch was resolving under the appropriate antibiotic therapy. Cardiopulmonary resuscitation was performed subsequently, on the 38th hospitalization day, but in vain. The relevant literature is reviewed, including the risk factors, clinical symptoms, diagnosis, and management of nocardiosis.