Title : Cerebral abscess revealing nocardiosis in a patient with systemic lupus erythematosus
Abstract:
Introduction: Nocardiosis has been iden)fied as a rare case by laboratory inves)ga)on, which was based largely on Nocardia. It is an isolated, rare, and opportunis)c bacterial infec)on arising from a gram-posi)ve bacterium in the environment. It tends to be found more o?en among immunocompromised pa)ents, as are o?en SLE pa)ents, but its diagnosis remains problema)c because of its variable clinical features and isola)on problem.
Case Presentation: We report the case of a 29-year-old female with a 10-year history of type 1 diabetes and a 9-year history of SLE on cor)costeroid and hydroxychloroquine treatment who presented to CHU Ibn Rochd, Casablanca, with le?-sided hemiparesis. She presented with painful, fluctua)ng skin lesions that had con)nued for 15 days but did not respond to empirical an)bio)cs. The pa)ent subsequently began to suffer from severe headaches, dysarthria, and hemiparesis, leading to a brain CT scan iden)fying several cerebral abscesses. Eventually, however, despite our ini)al empirical an)bio)cs, her condi)on worsened and she underwent surgical drainage. Extended culture incuba)on finally confirmed the diagnosis of Nocardia farcinica, promp)ng a change to therapy. As the pa)ent's condi)on worsened, she developed a subcutaneous abdominal abscess that must be removed surgically. This pa)ent eventually died from sep)c shock and mul)visceral failure, despite aggressive treatment. It is not uncommon for the diagnosis of nocardiosis to be very difficult in pa)ents with SLE, although it is already linked to the illness. Pa)ents diagnosed with SLE usually have an uncommon diagnosis and the clinical presenta)on is non-specific, thus rendering appropriate therapy o?en non-frequent, hence the central importance of maintaining high suspicion of nocardiosis index for immunocompromised pa)ents. Iden)fica)on and adjustment of an)bio)c therapy promptly is essen)al to improve outcomes; however, difficul)es in clinical diagnosis and monitoring of nocardiosis illustrate the difficulty of managing this infec)on in these very at-risk popula)ons.
