Chengsupanimit Tayoot, Mahajan Amit, Farhadian Shelli, Machiavello Roman Francisco
Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, United States.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States.
Front Med (Lausanne). 2025 Jun 5;12:1613770. doi: 10.3389/fmed.2025.1613770. eCollection 2025.
A middle-aged man, renal transplant recipient, was admitted with lower extremity paralysis, loss of sensation and urinary retention. The initial diagnostic workup revealed extensive inflammatory spinal changes on imaging, consistent with longitudinally extensive transverse myelitis. Cerebrospinal fluid testing demonstrated neutrophilic pleocytosis; routine tests for bacterial and viral pathogens were negative. The patient received high-dose steroids for presumed autoimmune myelitis, but his condition worsened. Repeat spinal imaging revealed an intramedullary spinal cord abscess and a loculated collection in the cauda equina. was isolated from spinal biopsy tissue cultures and metagenomic sequencing of cerebrospinal fluid. He received treatment with trimethoprim-sulfamethoxazole and linezolid, with subsequent improvement of the radiological abnormalities. At outpatient follow-up two months after initiating antimicrobials, the patient endorsed improved upper extremity strength, though remained paraplegic. This case report highlights the protean manifestations of central nervous system nocardiosis and the benefits of using metagenomic sequencing to diagnose complex central nervous system infections.
一名中年男性，肾移植受者，因下肢瘫痪、感觉丧失和尿潴留入院。初始诊断检查显示影像学上有广泛的脊髓炎性改变，符合纵向广泛横贯性脊髓炎。脑脊液检查显示中性粒细胞增多；细菌和病毒病原体的常规检测均为阴性。该患者因推测为自身免疫性脊髓炎接受了大剂量类固醇治疗，但病情恶化。重复脊髓成像显示髓内脊髓脓肿和马尾区有局限性积液。从脊髓活检组织培养物和脑脊液宏基因组测序中分离出[病原体名称未给出]。他接受了甲氧苄啶 - 磺胺甲恶唑和利奈唑胺治疗，随后影像学异常有所改善。在开始使用抗菌药物两个月后的门诊随访中，患者认可上肢力量有所改善，尽管仍为截瘫。本病例报告强调了中枢神经系统诺卡菌病的多种表现形式以及使用宏基因组测序诊断复杂中枢神经系统感染的益处。
