Roquer J, Pou A, Herraiz J, Campodarve I, Sequeira T, Vilató J, Alameda F, Serrano R
Department of Neurology, Hospital de l'Esperança, Barcelona, Spain.
Eur Neurol. 1990;30(5):254-7. doi: 10.1159/000117357.
We report a case of a primary cerebral abscess due to Nocardia asteroides in a nonimmunocompromised patient with a particular clinical course. The first symptom (right subacute brachial palsy) and the lesion in a computed tomographic (CT) scan (left parietofrontal edema suggestive of brain tumor) disappeared after corticosteroid treatment and the patient was discharged with total recovery. After 2 months she complained of headache and visual disturbance. A new CT scan showed an annular lesion in the left occipital lobe. A cerebral biopsy was diagnosed of nocardia infection. The patient died 2 weeks after this biopsy. A postmortem study showed an occipital brain abscess but not structural abnormalities were seen in the left parietofrontal area. We believe that the first episode could be a local inflammatory response to cerebral implantation of nocardia which disappeared clinically in the CT scan and in the postmortem study after corticosteroid treatment. Then the nocardia could have displaced by the hematological route to the second and definitive cerebral lesion.
我们报告了一例非免疫功能低下患者因星形诺卡菌引起的原发性脑脓肿病例，该病例具有特殊的临床病程。首例症状（右亚急性臂丛神经麻痹）以及计算机断层扫描（CT）中的病变（左额顶叶水肿提示脑肿瘤）在皮质类固醇治疗后消失，患者出院时已完全康复。两个月后，她出现头痛和视觉障碍。新的CT扫描显示左枕叶有环形病变。脑活检诊断为诺卡菌感染。活检后两周患者死亡。尸检研究显示有枕叶脑脓肿，但左额顶叶区域未见结构异常。我们认为，首例发作可能是对诺卡菌脑植入的局部炎症反应，经皮质类固醇治疗后，在CT扫描及尸检研究中临床症状消失。然后，诺卡菌可能通过血液途径转移至第二个也是最终的脑病变部位。
