Journal
EUROPEAN JOURNAL OF NEUROLOGY
Volume 28, Issue 1, Pages 355-357Publisher
WILEY
DOI: 10.1111/ene.14533
Keywords
Ziehl‐ Neelsen stain; metagenomics next‐ generation sequencing; Nocardia asiatica; brain abscess; diagnosis
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A 61-year-old woman with a brain abscess caused by N. asiatica was swiftly diagnosed using a combination of Ziehl-Neelsen staining and mNGS. The patient, who had left breast cancer resection, diabetes mellitus, and a 7-month history of cough and fever, was successfully treated with linezolid and trimethoprim-sulfamethoxazole until complete recovery was confirmed by follow-up cerebral MRI.
Background and purpose Early and accurate diagnosis is vital in cerebral nocardiosis, a very rare and infectious disease associated with a high mortality rate. Herein, we report a case that a patient with brain abscess was swiftly diagnosed and successfully treated. Methods We report a case of a 61-year-old woman with a brain abscess caused by Nocardia asiatica, diagnosed by a combination of Ziehl-Neelsen staining and metagenomics next-generation sequencing (mNGS). Results A 61-year-old woman with left breast cancer resection, diabetes mellitus and a 7-month discontinuous cough and fever was admitted to our hospital. On the third day of hospitalization, she experienced a sudden loss of consciousness and was diagnosed with a brain abscess and a pathological change in cerebral mass on brain magnetic resonance imaging (MRI). Due to the failure of culturing any microorganisms from the pup, the dissected sample from the patient with Ziehl-Neelsen staining tested positive for acid-fast bacilli and was subjected to mNGS. The pathogen was identified as N. asiatica and the patient was treated accordingly with linezolid and trimethoprim-sulfamethoxazole until complete recovery was confirmed by the follow-up cerebral MRI. Conclusions This is the first case report of a brain abscess caused by N. asiatica being swiftly diagnosed by a combination of Ziehl-Neelsen staining and mNGS. This rapid diagnosis allowed us to successfully treat this rare infection.
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