Nocardial cerebellar abscess successfully treated with short-term minocycline treatment in an immunocompetent patient

Abstract

We present a 61-year-old immunocompetent man with cerebellar abscess caused by Nocardia spp. The patient came to our hospital because of progressive consciousness disturbance. The patient's past medical history was not significant for immunodeficiency. CT demonstrated a right cerebellar mass lesion and obstructive hydrocephalus. Contrast Enhanced MRI demonstrated multiple ring-enhanced cerebellar cystic lesions. Intra-cystic fluid showed remarkable hyper-intensity on diffusion-weighted MRI. Posterior fossa decompression and echoguided aspiration were performed. The diagnosis of Nocardial cerebellar abscess was obtained by culture. Though the residural lesions were not diminished by TMP/SMX (ST) and meropenem (MEPM), these lesions were diminished by oral administration of minocycline (MINO). Due to drug-induced hepatitis, it was necessary to discontinue MINO after 6 weeks. However, there have not been any relapses of cerebral nocardiosis for 11 months postoperatively. Brain abscesses caused by Nocardia are rare, especially in immnocompetent patients. Standard treatment guidelines for cerebral nocardiosis were unavailable, and the mortality rate remains high. Though long-term follow-up remains necessary, stereotactic aspiration and sensitive antibiotic therapy have been successful in the short term.