Zhang Yue, Qi Zhongchun, Li Hua, Gao Hui
Department of Oncology, General Hospital of Western Theatre Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610000, People's Republic of China.
BMC Infect Dis. 2025 Jan 8;25(1):42. doi: 10.1186/s12879-025-10445-0.
Nocardia are widely present in nature and considered opportunistic pathogens. They can result in hematogenous spread infection through the ruptured skin or respiratory tract when the host's immune system is compromised. Currently, 119 species of Nocardia have been identified, with 54 capable of causing infections in humans. Nocardial brain abscesses are a rare intracranial lesion that accounts for only 2% of all brain abscesses, but have a mortality rate of 20-55%. This article reports a successfully cured case of mediastinal Nocardia infection with disseminated brain abscess.
The patient presented with intermittent chills, shivering, and fever, with the highest temperature of 39˚C, accompanied by shoulder and back pain, dizziness, and headaches. A chest-enhanced computed tomography (CT) revealed multiple enhanced nodulars in the bilateral hilum and mediastinum. A head-enhanced CT revealed scattered multiple ring-enhanced nodules in both cerebral hemispheres and the left cerebrum, accompanied by extensive surrounding edema. The mediastinal puncture tissue culture confirmed the growth of Nocardia. After twice discussions with multidisciplinary team (MDT) to rule out the possibility of mediastinal and intracranial metastatic tumors, we promptly initiated treatment with a triple-drug antibiotic regimen consisting of imipenem/cilastatin sodium, linezolid dextrose, and Trimethoprim-sulfamethoxazole (TMP-SMX). The patient ultimately achieved complete remission.
Mediastinal nocardiosis with disseminated brain abscesses is a rare condition that can be difficult to differentiate from brain metastases caused by lung cancer. Bacterial culture results, imaging features, and MDT discussions are crucial for accurate diagnosis and treatment. A triple-drug antibiotic regimen has been found to be effective in treatment with acceptable levels of toxicity.
诺卡菌广泛存在于自然界，被认为是机会性致病菌。当宿主免疫系统受损时，它们可通过破损皮肤或呼吸道导致血行播散性感染。目前，已鉴定出119种诺卡菌，其中54种可引起人类感染。诺卡菌性脑脓肿是一种罕见的颅内病变，仅占所有脑脓肿的2%，但死亡率为20% - 55%。本文报告1例成功治愈的纵隔诺卡菌感染合并播散性脑脓肿病例。
患者出现间歇性寒战、发抖和发热，最高体温39˚C，伴有肩背部疼痛、头晕和头痛。胸部增强计算机断层扫描（CT）显示双侧肺门和纵隔有多个强化结节。头部增强CT显示双侧大脑半球和左侧大脑有散在的多个环形强化结节，伴有广泛的周围水肿。纵隔穿刺组织培养证实有诺卡菌生长。在与多学科团队（MDT）进行两次讨论以排除纵隔和颅内转移瘤的可能性后，我们迅速开始使用由亚胺培南/西司他丁钠、利奈唑胺葡萄糖和复方磺胺甲恶唑（TMP - SMX）组成的三联抗生素方案进行治疗。患者最终实现完全缓解。
纵隔诺卡菌病合并播散性脑脓肿是一种罕见疾病，可能难以与肺癌引起的脑转移相鉴别。细菌培养结果、影像学特征和MDT讨论对于准确诊断和治疗至关重要。已发现三联抗生素方案在治疗中有效且毒性水平可接受。
