Nocardia farcinica meningitis in a patient with high-grade astrocytoma

  • Elahe Nasri Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Hamed Fakhim Department of Medical Parasitology and Mycology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
  • Aleksandra Barac Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Saber Yousefi Department of Microbiology and Virology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
  • Kouros Aghazade Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, Iran
  • Darko Boljevic ”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, Serbia
  • Massoud Mardani Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Keywords: Nocardia farcinica, meningitis, brain abscess, astrocytoma

Abstract

We describe a case of 91-year-old male with astrocytoma who developed meningitis caused by Nocardia farcinica. He had a past medical history of anaplastic astrocytoma grade III. Endocranial computed tomography (CT) scan revealed mass lesion in the left occipital region associated with perilesional edema, without evidence of midline shift issue. The analyses of cerebrospinal fluid (CSF) revealed neutrophilic pleocytosis, hyperproteinorrachia and hypoglycorrhachia. Combined antimicrobial therapy was initiated (vancomycin, meropenem, acyclovir). CSF culture revealed Nocardia farcinica. Susceptibility testing revealed intermediate sensitivity to meropenem and antibiotic treatment was switched to trimethoprim-sulfamethoxazole and imipenem. After 7 days of treatment the patient developed progressive dyspnea. The chest CT scan revealed bilateral pleural effusion and alveolar infiltrate mostly in the right lobe. Ceftriaxone was added to the therapy, but the outcome was lethal. Nocardia spp. should be considered as differential diagnosis in the patients with brain tumor or meningitis in the setting of immune suppression and corticosteroid use. CSF cultures should be incubated longer with aim to allow fastidious organisms to grow, such as Nocardia spp.

Published
2019-09-30
How to Cite
1.
Nasri E, Fakhim H, Barac A, Yousefi S, Aghazade K, Boljevic D, Mardani M (2019) Nocardia farcinica meningitis in a patient with high-grade astrocytoma. J Infect Dev Ctries 13:854-857. doi: 10.3855/jidc.11582
Section
Case Reports