PRIMARY NOCARDIAL MENINGITIS IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Nocardia is an important but often overlooked opportunistic infection agent in immunocompromised hosts. Nocardiosis is primarily pulmonary; central nervous system involvement, usually in the form of brain absce ss, is less common. Primary nocardial meningitis without associated br ain abscess and pulmonary lesion is extremely rare and poses a formida ble diagnostic challenge. We report on a patient with systemic lupus e rythematosus who presented with a clinical picture of chronic meningit is which failed to respond to empirical antibiotic treatment. She dete rioriated and succumbed. Post-mortem examination showed nocardial meni ngitis without associated brain abscesses. Nocardial meningitis should be considered a differential diagnosis of subacute meningitis in immu nocompromised hosts.