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Brain Abscess Caused by Nocardia sp. in an HIV Patient: A Case Report Highlighting Challenges and Treatment Success
Tahani M Ghazawi1, Mohammed Alhazmi1, Hanan A Bakri2
1Infectious Diseases Department, King Fahd Central Hospital, Jazan, Saudi Arabia.
Background:
Nocardia brain abscess is a rare opportunistic infection in people living with HIV at an advanced stage. Immunosuppression, especially with very low CD4 counts and non-adherence to treatment, increases the risk. These infections are diagnostically challenging due to their nonspecific presentation and the limited sensitivity of routine molecular panels in detecting Nocardia.
Case Presentation:
We present a 57-year-old HIV-positive female who developed a brain abscess after discontinuing antiretroviral therapy (ART) in 2019. She presented in 2023 with progressive headaches, fever, and vomiting. MRI revealed a ring-enhancing lesion, suggesting a brain tumor or severe infection. Craniotomy with pus aspiration confirmed Nocardia sp. The patient was treated with trimethoprim/sulfamethoxazole (TMP-SMX) and imipenem-cilastatin, showing sig-nificant improvement after two weeks of intravenous therapy. The patient was then discharged on oral TMP-SMX.
Conclusion:
This case highlights the diagnostic challenges of nocardial brain abscesses in pa-tients with HIV and highlights the importance of diagnosis, early neurosurgical intervention, and targeted antimicrobial therapy in improving outcomes.
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