[Brain abscess due to Nocardia sp. In an immunocompetent patient in Peru: a case report]

Area of Science:

• Neurology
• Infectious Diseases
• Medical Microbiology

Background:

• Cerebral nocardiosis is uncommon, predominantly affecting immunocompromised individuals.
• No established first-line treatment guidelines exist for cerebral nocardiosis.
• Multiple brain abscesses necessitate a broad differential diagnosis.

Observation:

• An immunocompetent older adult presented with encephalopathy and hemiparesis.
• Imaging revealed multiple brain abscesses suggestive of an infectious etiology.
• Initial treatments for tuberculosis, bacterial abscess, and toxoplasmosis were ineffective.

Findings:

• Empirical treatment with meropenem and trimethoprim/sulfamethoxazole led to clinical and imaging improvement.
• Adverse events necessitated temporary use of alternative medications.
• Nocardiosis should be considered in the differential diagnosis of multiple brain abscesses.

Implications:

• This case underscores the importance of considering nocardiosis in unexplained multiple brain abscesses, even in immunocompetent patients.
• Early empirical treatment with specific antibiotics can be effective.
• Further research is needed to establish definitive treatment guidelines for cerebral nocardiosis.