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Abstract

Background

Nocardia brain abscess is a rare opportunistic infection in people living with HIV at an advanced stage. Immunosuppression, especially with very low CD4 counts and non-adherence to treatment, increases the risk. These infections are diagnostically challenging due to their nonspecific presentation and the limited sensitivity of routine molecular panels in detecting Nocardia.

Case presentation

We present a 57-year-old HIV-positive female who developed a brain abscess after discontinuing antiretroviral therapy (ART) in 2019. She presented in 2023 with progressive headaches, fever, and vomiting. MRI revealed a ring-enhancing lesion, suggesting a brain tumor or severe infection. Craniotomy with pus aspiration confirmed sp. The patient was treated with trimethoprim/sulfamethoxazole (TMP-SMX) and imipenem-cilastatin, showing significant improvement after two weeks of intravenous therapy. The patient was then discharged on oral TMP-SMX.

Conclusion

This case highlights the diagnostic challenges of nocardial brain abscesses in patients with HIV and highlights the importance of diagnosis, early neurosurgical intervention, and targeted antimicrobial therapy in improving outcomes.

© 2025 Bentham Science Publishers
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2025-10-23
2025-12-05

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References

  1. Usman M. Mansoor V.B. Akhtar N. Miraj M.A. Nocardia brain abscess in a patient with advanced HIV-AIDS: Case report. J Rawalpindi Med Coll 2023 27 3 10.37939/jrmc.v27i3.2252
    [Google Scholar]
  2. Nieves Perez C.A. Sánchez Pérez M.J. Vargas A.S. Franco M.A. Molina Obana M.C. Cerebral abscess due to nocardia beijingensis associated with HIV: Case report and mini review. Cureus 2023 15 10 47571 10.7759/cureus.47571 38021684
    [Google Scholar]
  3. Meena D.S. Kumar D. Bohra G.K. Midha N. Garg M.K. Clinical characteristics and treatment outcome of central nervous system nocardiosis: A systematic review of reported cases. Med. Princ. Pract. 2022 31 4 333 341 10.1159/000525509 35700710
    [Google Scholar]
  4. Performance Standards for Susceptibility Testing of Mycobacteria Nocardia spp., and Other Aerobic Actinomycetes; CLSI supplement M62. 2022 Available from: https://webstore.ansi.org/standards/clsi/clsim24s?gad_source=1&gad_campaignid=22352210635&gbraid=0AAAAArA_aWam3ihRWveO_AKsGoX5WiQ3G&gclid=CjwKCAjw_fnFBhB0EiwAH_MfZmR7aii3vyGfMAo0p_e1apg_XoAUO2_ZcyJ8Wgu8VRpMrSwxfPuxvxoCW2YQAvD_BwE
  5. Brouwer M.C. Coutinho J.M. van de Beek D. Clinical characteristics and outcome of brain abscess. Neurology 2014 82 9 806 813 10.1212/WNL.0000000000000172 24477107
    [Google Scholar]
  6. Corsini Campioli C. Castillo Almeida N.E. O’Horo J.C. Clinical presentation, management, and outcomes of patients with brain abscess due to Nocardia species. Open Forum Infect. Dis. 2021 8 4 ofab067 10.1093/ofid/ofab067 33855101
    [Google Scholar]
  7. Beucler N. Farah K. Choucha A. Nocardia farcinica cerebral abscess: A systematic review of treatment strategies. Neurochirurgie 2022 68 1 94 101 10.1016/j.neuchi.2021.04.022 33989644
    [Google Scholar]
  8. Zhang Y Zhu W li Q Nocardial brain abscess in an immunocompetent patient and review of literature. Chin Neurosurg J 2016 2 1 26 10.1186/s41016‑016‑0043‑6
    [Google Scholar]
  9. Mylona E. Golfinopoulou S. Tragousti A. Skoutelis A. Primary Nocardia farcinica brain abscess with secondary relapsing meningitis in an immunocompromised patient. J. Med. Cases 2015 6 7 304 306 10.14740/jmc2157w
    [Google Scholar]
  10. Xue K. Zhang A. Liu S. Chen D. Multiple brain abscesses caused by Nocardia farcinica infection after hand injury: A case report and literature review. Medicine (Baltimore) 2024 103 29 39019 10.1097/MD.0000000000039019 39029015
    [Google Scholar]
  11. Yu L. Yan J. Zhang Z. Li F. Zheng R. Shi J. Brain abscess caused by Nocardia farcinica in a person living with HIV. BMC Infect. Dis. 2024 24 1 1100 10.1186/s12879‑024‑10014‑x 39363255
    [Google Scholar]
  12. Fan N. Fang H. Huang F. Metagenome next-generation sequencing plays a key role in the diagnosis and selection of effective antibiotics on the treatment of Nocardia pneumonia: A case report. Front. Med. 2024 11 1373319 10.3389/fmed.2024.1373319 38860208
    [Google Scholar]
  13. Deng C. Lo S.K.F. Chiu K.H.Y. Xing F. Nocardia detection in respiratory samples using targeted next-generation sequencing: Cautious interpretation is necessary for timely discovery. Infect Microbes Dis 2025 7 2 101 110 10.1097/IM9.0000000000000179
    [Google Scholar]
  14. Zhao Y. Zhang W. Zhang X. Application of metagenomic next-generation sequencing in the diagnosis of infectious diseases. Front. Cell. Infect. Microbiol. 2024 14 1458316 10.3389/fcimb.2024.1458316 39619659
    [Google Scholar]
  15. Xing F. Xia Y. Lu Q. Lo S.K.F. Lau S.K.P. Woo P.C.Y. Rapid diagnosis of fatal Nocardia kroppenstedtii bacteremic pneumonia and empyema thoracis by next-generation sequencing: A case report. Front. Med. 2023 10 1226126 10.3389/fmed.2023.1226126 37534314
    [Google Scholar]
/content/journals/chr/10.2174/011570162X400808251013150817
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Brain Abscess Caused by Nocardia sp. in an HIV Patient: A Case Report Highlighting Challenges and Treatment Success
Bentham Science Publishers ; https://doi.org/10.2174/011570162X400808251013150817
/content/journals/chr/10.2174/011570162X400808251013150817
/content/journals/chr/10.2174/011570162X400808251013150817
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  • Article Type:     Case Report
Keywords: brain abscess ; antimicrobial therapy ; Nocardia sp. ; HIV ; immunosuppression ; outcomes

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