Intracerebral abscess caused by Nocardia otitidiscaviarum in a renal transplant patient-cured by evacuation plus antibiotic therapy

We present a 50-year-old female who experienced generalized convulsion 3 mo nths after a successful cadaveric renal transplantation. The first cerebral CT scan indicated cerebral frontal infarction. Repeat CT some days later r evealed progressive lesions, and a highly malignant tumor or abscess was su spected. Antifungal and broad-spectrum antibacterial therapy was initiated. Cerebral MRI could not differentiate between these conditions, but a neutr ophil granulocyte scan strongly suggested an infectious process. A stereota ctic puncture of the frontal lobe was followed by temporary improvement. A severe progressive left-sided hemiparalysis gave indication for a craniotom y with evacuation of the abscess 9 days later. Culture of aspirated pus yie lded growth of a gram-positive, rod-shaped bacterium, later identified as N ocardia otitidiscaviarum by sequencing the 16S rRNA, The patient was treate d with meropenem plus rifampicin intravenously for 6 weeks followed by oral ciprofloxacin and rifampicin for 2 months. Due to pharmacokinetic interact ion with rifampicin, the prednisolone dose was doubled, and the dose of tac rolimus had to be tripled for maintenance of adequate trough concentrations . Five months following cessation of antibiotic treatment, the patient has regained normal strength and function in her left-sided extremities and has a serum creatinine level of about 160 mu mol/l (1.8 mg/dl). Copyright (C) 2000 S. Karger AG, Basel.