Abstract Details

Title Nocardia Spinal Abscess in the Immunocompetent Patient

Topic Infectious Disease

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-002

Background Nocardiosis is typically an opportunistic infection in patients with severe immunodeficiencies. We present a case of a 70 year-old man with diabetes mellitus who presented with multiple ring-enhancing lesions in the brain. He was eventually diagnosed with Nocardia spinal abscess resulting in quadriplegia and mortality. Other than diabetes, the patient had no overt immunodeficiency. Given that Nocardia has been described in immunocompetent individuals¹, special consideration should be given to opportunistic CNS infections in individuals with non-specific findings and who lack obvious immunodeficiency.

Objective Discussion of Nocardia spinal abscess.

Design/Methods Review of medical records and imaging.

Results A 70 year-old man with diabetes mellitus presented to our institution with quadriparesis, encephalopathy, and urinary retention. MRI Brain showed multiple circular ring-enhancing lesions and lumbar puncture demonstrated mild lymphocytic pleocytosis and 5 oligoclonal bands without infectious profile. He was treated with steroids with some improvement in motor strength and discharged to rehabilitation. The patient developed quadriplegia and returned for evaluation. MRI brain showed resolution of ring-enhancing lesions and MRI cervical spine showed a new elongated cervical spine lesion concerning for intramedullary abscess. Patient underwent cervical laminectomy with biopsy of the spine lesion, which ultimately revealed Nocardia farcinica. Despite treatment with IV antibiotics, the patient’s respiratory status declined and he was transitioned to comfort measures three days after surgery.

Conclusions This case describes a presentation of Nocardia abscess in a patient without overt immunodeficiency aside from diabetes¹. Nocardiosis is typically described as an opportunistic infection in patients with severe immunodeficiencies such as HIV, hematologic malignancies, or on chronic immunosuppression with corticosteroids or other agents. The mortality rate of Nocardia brain abscess in the immunocompetent patient ranges from 20%-66% for solitary and multiple abscesses, respectively². Given the increasing prevalence of patients with diabetes, opportunistic CNS infections must be considered in multifocal brain lesions, even in the seemingly immunocompetent patient.

Authors/Disclosures
Jennifer H. Newman, MD (Jefferson Neurology) PRESENTER	Dr. Newman has nothing to disclose.
Emily Casaletto (Sidney Kimmel Medical College)	Miss Casaletto has nothing to disclose.
	No disclosure on file
Tzu-ying Chuang, MD, PhD	Dr. Chuang has nothing to disclose.
Muhammad Athar	No disclosure on file