Gordonia sputi related multiple brain abscesses, an AIDS-presenting illness: Thinking outside the box

HIV/AIDS has been recognized as a global health issue with significant burden on healthcare services worldwide. Diagnostic and therapeutic challenges include wide range of difficult to identify and treat infections. Gordonia sputi is known to cause multi-system infections in setting of HIV/AIDS. It is often difficult to isolate this organism requiring high suspicion index and special testing techniques. While there is no guidelines-recommended antibacterials regimen for Gordonia sputi infection, extended combined broad spectrum antibacterials have been successfully used. Our patient in this report is a 50-year-old male with no past history who presented with progressive weakness on the right side of the body and urinary incontinence over the duration of one month. MRI scan of the brain showed bilateral ring-enhancing lesions. Gordonia sputi was identified from a tissue biopsy using 16S ribosomal RNA sequencing technique. HIV test for antibodies came to be reactive and a CD4 cell count of 7/μL. The patient was treated with combination of antibacterials and had remarkable radiological interval changes and relatively slower yet apparent clinical improvement. Unfortunately, and despite initial recovery, patient has later developed multi-drug resistant hospital acquired pneumonia leading to his death in ICU during course of hospitalization. Treatment of Gordonia sputi in setting of HIV infection with a combination of antibacterials over extended period appears to be safe and effective. To our knowledge, this is the first report of Gordonia sputi related multiple brain abscesses as AIDS-presenting illness.