Primary nocardial brain abscess in a renal transplant patientReport as inadecuate

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BMC Research Notes

, 8:701



BackgroundIntracranial abscesses are rare among transplant recipients, and Nocardia is responsible for less than 2 % of them. Nocardiosis, a chronic infection and is difficult to treat. Primary infection involves lungs and eventually disseminates. Primary nocardial abscesses are rare and we report a case from Sri Lanka.

Case presentationA 38 year old Sri Lankan, who has received his 2nd ABO matched live donor transplantation, which was complicated with perinephric hematoma and massive transfusion syndrome. He presented with fever, worsening headache and papilledema. An urgent magnetic resonance image MRI showed an occipital abscess with midline shift. Craniotomy and drainage followed by 3 week course of imipenem and levofloxacin, which rendered him symptom free. After 12 months he has stayed recurrence free. Imaging and bacteriology of the respiratory tract failed to demonstrate Nocardia infection.

ConclusionIsolated Primary nocardial brain abscess are rare, and have an excellent response to medical therapy. We achieved a good response from a relatively short course of antibiotics not using sulfonamides, due to allergy, where long courses of antibiotic had been the norm.

KeywordsCerebral abscess Nocardia Renal transplantation Short antibiotic course AbbreviationsMRImagnetic resonance image

ESRDend stage renal failure

RTrenal transplant

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Author: Ranga Migara Weerakkody - Dhammika Randula Palangasinghe - Saman Wadanambi - Eranga Sanjeewa Wijewikrama



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