Cerebral nocardiosis--clinical and pathological findings in three patients

Cerebral nocardiosis is an uncommon but increasingly diagnosed infection in Australia. We report three cases. One occurred in an immunosuppressed male in whom the diagnosis was made at autopsy, one in an otherwise healthy elderly woman with subcutaneous nocardiosis, and the third was a posterior fossa nocardial abscess without systemic involvement occurring in a previously healthy woman after surgical excision of a meningioma. Primary cerebral nocardiosis is rare, with only two cases of primary posterior fossa nocardiosis reported. The cases highlight the difficulty of diagnosis and the need for aggressive treatment with a combined approach of surgical drainage and antibiotic therapy. The antibiotic regime of choice is the subject of controversy. Rifampicin, cephalosporins, imipenem, sulphonamides and other agents were used with varying success in our patients. Cerebral nocardiosis should be considered in any patient with a cerebral space occupying lesion.