Disseminated nocardiosis: A rare presentation with surgical emergency

ObjectiveThe purpose of this report is to present an atypical manifestation of primary cutaneous nocardiosis disseminating to the brain, ear and epidural space resulting in an abscess formation and subsequently acute cord compression. If presented with epidural abscess with acute cord compression, it is a surgical emergency.Case reportA 47 year old post renal transplant patient had right lower limb monoplegia with mixed upper and lower motor neuron signs which could not be corroborated. MRI of the whole spine could characterize a lumbar epidural abscess. She was operated laminectomy decompression of L3 and lavage done. Brain MRI showed multiple brain abscesses. Culture and microscopy identified nocardia species. Linezolid and cotrimoxazole was started. She responded fast to recover completely in three months.ConclusionThe clinician should maintain a high index of suspicion for Nocardia infection when dealing with immunocompromised patients with atypical presentation especially with neurological involvement. The diagnosis of Nocardia infection is made via culture and specimen smear morphology. Balanced surgical and medical line of treatment is to be individualized for each patient according to the dissemination, phenotype and host status.