Primary Brain Abscess Due to Nocardia cyriacigeorgica in a patient with renal transplantation: Case Report.

Abstract

Nocardia is an opportunistic pathogen affecting immunosuppressed patients. This case report aims to present a primary brain abscess due to Nocardia cyriacigeorgica in an immunosuppressed kidney transplant patient. An 48-year-old female patient presented to the emergency department with complaints of sudden onset of headache and confusion. The patient had a history of renal transplantation (one year previously). CT scans were performed due to blurred consciousness, with an appearance compatible with a cystic necrotic lesion with haemorrhagic densities around the left parietooccipital. Since the patient was immunosuppressive, broad-spectrum antibiotics were started. All necessary medical examinations were completed immediately and the patient underwent a transcranial operation. The abscess fluid and lesion were completely removed along with the capsule. The surgical material was sent to the Microbiology laboratory. The culture reported Nocardia cyriacigeorgica as the pathogen. The patient died on the 17th postoperative day due to clinical presentation of DIC. As a conclusion, considering CNS nocardiasis, routine contrast-enhanced brain imaging and rapid microbiological diagnosis are of vital importance, especially in immunosuppressed patients. Resistance was largely species-specific for Nocardia spp. Identification of Nocardia at the species level and early initiation of treatment with the most appropriate drug according to its antimicrobial susceptibility will lead to success in treatment and reduce mortality rates.