Nocardia farcinica meningitis in a patient with high-grade astrocytoma
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...
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The Journal of Infection in Developing Countries
2019-09-01
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| Series: | Journal of Infection in Developing Countries |
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| Online Access: | https://jidc.org/index.php/journal/article/view/11582 |
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| author | Elahe Nasri Hamed Fakhim Aleksandra Barac Saber Yousefi Kouros Aghazade Darko Boljevic Massoud Mardani |
| author_facet | Elahe Nasri Hamed Fakhim Aleksandra Barac Saber Yousefi Kouros Aghazade Darko Boljevic Massoud Mardani |
| author_sort | Elahe Nasri |
| collection | DOAJ |
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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.
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| format | Article |
| id | doaj-art-2ae9e6e8f3bc4337910fdf1fdb467976 |
| institution | Kabale University |
| issn | 1972-2680 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-2ae9e6e8f3bc4337910fdf1fdb4679762025-08-20T03:52:43ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802019-09-01130910.3855/jidc.11582Nocardia farcinica meningitis in a patient with high-grade astrocytomaElahe Nasri0Hamed Fakhim1Aleksandra Barac2Saber Yousefi3Kouros Aghazade4Darko Boljevic5Massoud Mardani6Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Medical Parasitology and Mycology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IranClinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, SerbiaDepartment of Microbiology and Virology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, IranInfectious Diseases Research Center, AJA University of Medical Sciences, Tehran, Iran”Dedinje” Cardiovascular Institute, Belgrade, Serbia, School Of Medicine, University of Belgrade, Belgrade, SerbiaInfectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 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. https://jidc.org/index.php/journal/article/view/11582Nocardia farcinicameningitisbrain abscessastrocytoma |
| spellingShingle | Elahe Nasri Hamed Fakhim Aleksandra Barac Saber Yousefi Kouros Aghazade Darko Boljevic Massoud Mardani Nocardia farcinica meningitis in a patient with high-grade astrocytoma Journal of Infection in Developing Countries Nocardia farcinica meningitis brain abscess astrocytoma |
| title | Nocardia farcinica meningitis in a patient with high-grade astrocytoma |
| title_full | Nocardia farcinica meningitis in a patient with high-grade astrocytoma |
| title_fullStr | Nocardia farcinica meningitis in a patient with high-grade astrocytoma |
| title_full_unstemmed | Nocardia farcinica meningitis in a patient with high-grade astrocytoma |
| title_short | Nocardia farcinica meningitis in a patient with high-grade astrocytoma |
| title_sort | nocardia farcinica meningitis in a patient with high grade astrocytoma |
| topic | Nocardia farcinica meningitis brain abscess astrocytoma |
| url | https://jidc.org/index.php/journal/article/view/11582 |
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