Department of Oncology, University of London Saint George's, London, UK.
Department of Oncology, University of London Saint George's, London, UK
BMJ Case Rep. 2020 Sep 7;13(9):e233678. doi: 10.1136/bcr-2019-233678.
A 67-year-old man with metastatic prostate cancer and underlying asymptomatic pancytopenia presented with a 1-week history of general malaise, left leg weakness and facial numbness. Initial brain imaging demonstrated two rim-enhancing lesions felt to represent intracerebral metastasis. Following neurosurgical referral, a multidisciplinary meeting decision was made for best supportive care and dexamethasone was given. He developed multiple cutaneous lesions, which on incision and drainage revealed Repeat brain imaging showed enlargement of the existing cavitating lesions and appearance of new lesions, now typical of cerebral abscesses. A diagnosis of disseminated nocardiosis with cutaneous and intracerebral infection was reached. He started taking empirical treatment with intravenous meropenem, co-trimoxazole and subsequent addition of amikacin, with little improvement. On further review of sensitivities, moxifloxacin was added. Following over 1 month of antimicrobial treatment, his neurological symptoms, cutaneous lesions and repeat MRI of the brain had improved.
一位 67 岁患有转移性前列腺癌和潜在无症状全血细胞减少症的男性，出现了为期 1 周的全身不适、左腿无力和面部麻木症状。初步脑部成像显示两个边缘增强病变，被认为代表颅内转移。在神经外科转介后，多学科会议决定进行最佳支持治疗，并给予地塞米松。他出现了多个皮肤病变，切开引流后显示出空洞性病变的扩大和新病变的出现，现在典型的脑脓肿。诊断为播散性奴卡菌病，伴有皮肤和脑内感染。他开始接受经验性静脉注射美罗培南、复方磺胺甲噁唑治疗，随后加用阿米卡星，病情略有改善。进一步回顾药敏试验结果后，加用莫西沙星。经过 1 个多月的抗菌治疗，他的神经症状、皮肤病变和脑部 MRI 复查均有所改善。
