Nocardia brain stem abscess: diagnosis and response to medical therapy

A patient with a rapidly progressive brain stem syndrome is reported. CT scan showed a ring enhancing lesion in the pons and CSF examination showed elevated protein and pleocytosis. A pulmonary abscess containing Nocardia was found and antimicrobial therapy produced progressive reduction in size of the pontine lesion and clinical improvement without surgical drainage. This is the first documented diagnosis and survival of a medically treated patient with a brain stem abscess of presumed Nocardia etiology.