State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310000, Zhejiang, China.
BMC Infect Dis. 2020 Nov 17;20(1):856. doi: 10.1186/s12879-020-05569-4.
Disseminated Nocardia infection is a disease that is easily overlooked in patients with lesions occupying the intracranial space complicated with coma. Early diagnosis and treatment are crucial.
A 65-year-old man was admitted to the First Affiliated Hospital of Zhejiang University in October 2018 with weakness in the right limbs for 3 days and altered consciousness for 1 day. Five months earlier, he had been diagnosed with membranous kidney disease and had received cyclophosphamide and prednisone. At admission, the white blood cell count was 1.37 × 10/L (with 86.4% neutrophils), and C-reactive protein was 115.60 mg/L. Imaging examinations revealed a lesion occupying the intracranial space, lung infection, and multiple abscesses in the rhomboid muscle. The abscesses were drained. Pus culture confirmed Nocardia cyriacigeorgica infection. With antibiotics and vacuum-sealed drainage of the back wound, the patient improved and was discharged from the hospital.
This case report shows that infection should be considered during the differential diagnosis of lesions in the intracranial space, especially in patients receiving immunosuppressive treatment. In patients with disseminated N. cyriacigeorgica infection, combination antibiotic therapy and surgical drainage of localised abscesses can be effective.
颅内占位性病变合并昏迷的患者易发生播散性奴卡菌感染，易被忽视。早期诊断和治疗至关重要。
一名 65 岁男性因右侧肢体无力 3 天，意识改变 1 天，于 2018 年 10 月入住浙江大学第一附属医院。5 个月前，他被诊断为膜性肾病，并接受了环磷酰胺和泼尼松治疗。入院时，白细胞计数为 1.37×10/L（中性粒细胞 86.4%），C 反应蛋白为 115.60mg/L。影像学检查显示颅内占位性病变、肺部感染和菱形肌多处脓肿。脓肿被引流。脓液培养证实为触须奴卡菌感染。通过使用抗生素和背部伤口负压封闭引流，患者病情改善并出院。
本病例报告表明，在颅内占位性病变的鉴别诊断中应考虑感染，特别是在接受免疫抑制治疗的患者中。对于播散性 N. cyriacigeorgica 感染的患者，联合应用抗生素治疗和局部脓肿的手术引流可能是有效的。
