Recurrent nocardial brain abscesses treated by repeated stereotactic aspirations

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• A 61-year-old diabetic patient with a history of pulmonary sarcoidosis on chronic steroid therapy presented with new-onset simple partial seizures.
• Brain abscesses, particularly those caused by Nocardia asteroides, can present with complex neurological symptoms in immunocompromised individuals.

Purpose of the Study:

• To present a case of Nocardia asteroides brain abscess in a patient with risk factors including diabetes and chronic steroid use.
• To highlight the efficacy of repeated stereotactic aspiration as a minimally invasive treatment for nocardial brain abscesses.

Main Methods:

• Computed tomography (CT) scan identified a postcentral brain abscess.
• The abscess was initially aspirated under stereotactic guidance.
• Cultures identified Nocardia asteroides, and the patient was treated with intravenous trimethoprim and sulfamethoxazole.
• Two subsequent stereotactic aspirations were performed due to abscess recrudescence.

Main Results:

• Nocardia asteroides was identified as the causative agent of the brain abscess.
• The patient required multiple stereotactic aspirations to manage recurrent abscesses.
• Symptoms resolved following the treatment regimen, including repeated aspirations and antibiotic therapy.

Conclusions:

• Repeated stereotactic aspiration is a viable and effective alternative to open surgical procedures for treating nocardial brain abscesses.
• This approach may reduce patient morbidity associated with invasive surgery.
• Prompt diagnosis and targeted antibiotic therapy are crucial for managing Nocardia brain abscesses.