engleski

Complete recovery of a boy with systemic lupus erythematosus (SLE) and multiple nocardial brain abscesses

BACKGROUND AND AIMS: Nocardiosis is an opportunistic infection that might be associated with systemic lupus erythematosus (SLE). Lungs are the commonest site of infection, while central nervous system involvement is less common and is mostly due to haematogenous spread. We present a 13 year-old boy with SLE complicated with primary nocardial brain abscesses associated with meningitis which is extremely rare, especially in childhood. METHODS: Three days after we started therapy of SLE with pulse doses of steroids, the patient presented with headache, seizures, diplopia, paresis of the right abducens nerve and anisocoria. CT scan of the brain revealed multiple abscesses. Laboratory findings indicated possible microbial infection but at first all attempts to detect the possible cause of infection were unsuccessful. Repeated stereotactic biopsy after three weeks of the symptoms onset revealed the presence of Nocardia spp. Owing to the poor tolerance and side-effects of antibiotics (trimethoprim/sulfamethoxazole and linezolid), the patient was treated successfully by two switching of one drug to another. RESULTS: The complete resolution of brain abscesses and meningitis followed two months after the therapy was started. The relapse did not occur after 24 months of follow-up and SLE went into complete remission, due to continuous steroid therapy which was gradually reduced. CONCLUSIONS: In this case, it was very difficult to diagnose cerebral nocardiosis, and the definitive diagnosis was made after second stereotactic biopsy. We managed nocardial brain abscesses with antibiotic therapy, but the relevant improvement of patient’ s condition was noticed after the second stereotactic biopsy when a large abscess was drained, so we suggest that for the treatment of cerebral nocardiosis only antibiotic therapy would not be enough.

Nocardiosis; brain abscesses; SLE; child

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