Treatment of Nocardial Brain Abscess in a Patient With Systemic Lupus Erythematosus and Idiopathic Thrombocytopenic Purpura: Case Report and a Review of the Literature

Lauren Harris,Ioana Raducanu,Hu Liang Low

doi:10.7759/cureus.17498

Abstract

Brain abscesses due to Nocardia species account for 1-2% of all cerebral abscesses, often in immunosuppressed individuals, with a mortality three times higher than other cerebral abscesses. Early diagnosis and management are vital for good outcomes.We report a case of a right frontal Nocardia brain abscess in an immunosuppressed 38-year-old female. She presented with headaches, confusion, memory deficits, and personality change. She remained systemically well, with normal inflammatory markers. She underwent two open surgical drainages, with excision of the abscess wall. She made an excellent recovery with minimal edema and no contrast enhancement on imaging at eight weeks postoperatively.Management of Nocardia brain abscess includes a prompt diagnosis with direct microscopic examination and initiation of correct antibiotic therapy for good outcomes. We recommend open surgical resection, including excision of the abscess wall, followed by long-term antimicrobial therapy, to enhance the rate of recovery.

Highlights

We report a case of a right frontal Nocardia brain abscess in an immunosuppressed 38-year-old female
Over 30 Nocardia species are associated with human diseases, of which Nocardia asteroides, Nocardia brasiliensis, Nocardia farcinica, and Nocardia nova are the most prevalent [1]
We report a very rare case of an isolated nocardial brain abscess in a patient with systemic lupus erythematosus (SLE) and idiopathic thrombocytopenic purpura (ITP)

Summary

Introduction

Over 30 Nocardia species are associated with human diseases, of which Nocardia asteroides, Nocardia brasiliensis, Nocardia farcinica, and Nocardia nova are the most prevalent [1]. We report a very rare case of an isolated nocardial brain abscess in a patient with systemic lupus erythematosus (SLE) and idiopathic thrombocytopenic purpura (ITP). Enhanced computed tomography scans of her chest, abdomen, and pelvis revealed no abnormalities Given her normal C-reactive protein levels and the lack of any extracerebral lesions, the favored diagnosis was a primary brain neoplasm. Repeat scans three weeks later showed a significant recurrence of the lesion At this time, she underwent open drainage of the abscess as well as the removal of the abscess walls. MRI imaging was performed at two, four, and six months postoperatively, with continued improvement, minimal cavity, and no enhancement or perilesional edema. The initial neuropsychiatric symptoms resolved, and she resumed work after two months

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