GENERALIZED NOCARDIOSIS WITH MENINGOENCEP HALITIS IN A PATIENT WHO WAS NOT IMMUNOSUPPRESSED

Four weeks after an attack of pneumonia of unknown aetiology a 40-year -old woman was hospitalized because of a nonpurulent, predominantly ba sal meningoencephalitis and infratentorial abscesses. She had dysarthr ia, mild right-sided motor hemiparesis and central paresis affecting t he 7th cranial nerve. An area of fluctuating resistance, about 3 cm in diameter, was noticed over the left thigh. Serology indicated inflamm atory disease, but there was no immunodeficiency. The CSF showed lymph ocytic pleocytosis with mild protein increase but no evidence of infec tive agent. As tubercular meningitis was suspected she was treated wit h rifampicin (300 mg i. v. twice daily), isoniazid (300 mg i. v. once daily), streptomycin (800 mg i.m. once daily), cefotaxim (2.0 g i.v. t hree times daily), fluconazole (200 mg i.v. once daily) and dexamethas one (16-8-8 mg i. v.). She suddenly died two days after admission, pro bably as the result of central regulatory failure. Generalized nocardi osis involving lung, subcutaneous tissue and brain was revealed at aut opsy. -Although nocardiosis occurs predominantly in patients under imm unosuppression, this infection should be considered in the differentia l diagnosis of treatment-resistant pneumonia and meningoencephalitis w ithout obvious predisposition.