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Proceedings SNO “Percorsi clinici in Neuroscienze”

Figure 1. Brain MRI showing multiple nodular lesions in bilate-
ral occipital and frontal lobes, with ring enhancement in post-
contrast T1-weighted sequences, suspected to be multiple
brain abscesses.

blood and disseminate in other organs, particularly
the brain, causing abscess formation. Abscesses are
usually multiloculated, poorly encapsulated, and
(3,4)
about 40% are multifocal . Nocardiosis has a non-
specific clinical presentation, with subtle neurologi-
cal symptoms. Diagnosis is often late, can be com-
plex and made by isolating and identifiying the or-
ganism from sputum or pus, as well as from skin le-
was interrupted and cyclosporine dosage was re- sions as in our case. However, Nocardia can be diffi-
duced. However the patient got worse, became less cult to culture, several blood culture systems do not
alert and more confused and was transferred to hos- support growth and it may take up to 4 weeks to be
pice for the continuation of care. detected. Antibiotic therapy with Trimethoprim-sul-
famethoxazole is currently recommended as the first
line agent. For patients with pulmonary and dissemi-
DISCUSSION nated disease, awith subtle neurological symptoms
two or three antimicrobial regimen (amikacin, imipe-
Nocardiosis is a rare infectious disease caused by the nem, ceftriaxone) is recommended for empiric treat-
Nocardia bacteria that are Gram positive, aerobic ment. Disseminated Nocardiosis with CNS disease
bacteria, common worldwide in soil, water and de- should receive at least 12 months of antimicrobial
caying matter . More than 30 species have been as- therapy. Prognosis is poor with a high mortality rate,
(1)
sociated with human disease such as N. Brasieliensis, greater than 50%, in disseminated disease and in im-
N. Farcinica, N. Asteroides, N. Pseudobrasiliensis, N. munocompromised patients.
Nova. We report a case of disseminated nocardiosis with
The majority of infections (90%) occur in immuno- multiple brain abscesses in a renal transplanted
compromised people (lymphoma, transplantation, woman. Physicians should considered Nocardia in
glucocorticoid therapy, or AIDS) and N. farcinica in- immunocompromised patients (mainly transplanted)
fection is associated with a higher risk of dissemina- with CNS lesions and signs of an infectious disease
tion and antibiotic-resistance and, therefore, a higher involving the skin and lungs. Prompt identification of
mortality rate. the disease is crucial to initiate appropriate treatment
Nocardiosis usually results from direct inoculation of earlier in the course of the disease and improve pa-
the skin or soft tissues or by inhalation. Therefore the tient survival.
most common involved sites are the skin and lung ,
(2)
but in more than 50% the disease spreads through

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