We report a case of a 35-year-old man with
nocardiosis infection involving soft tissue and the central nervous system who had received a cadaveric donor kidney. The patient was admitted with
fever, malaise and right
shoulder pain. Soft tissue
abscess was seen on ultrasound examination. It was presumed due to gram (+) microorganisms, so 4 g day (IV)
ampicillin/sulbactam was started empirically once the
abscess was drained. Nocardia asteroides was found in the
pus specimen. On the second day in hospital, severe
headache,
ataxia and signs of meningeal irritation appeared. The cranial CT showed two intracranial
abscesses in the frontal lobe and cerebellum. We assumed Nocardia asteroides was the infective agent for the
cerebral abscesses, so
antibiotic therapy was switched to
trimethoprim-sulphamethox-asole (3x160/800 mg/d).
Nausea and
vomiting occurred on the fifth day of
therapy, improving after drainage from the frontal
abscess. However, these complaints recurred five days later. CT showed cerebellar
abscess had become bigger. The patient's complaints improved after the second surgical drainage. N. asteroides was again grown in the aspiration fluids of both
cerebral abscesses. Complete regression of the
abscesses was seen in the CT after two months.
Co-trimoxazole was continued for six months then withdrawn. Graft dysfunction was not observed. Early medical and surgical interventions may be life-saving in this potentially lethal disease.