NOCARDIOSIS OF THE CENTRAL NERVOUS SYSTEM: REPORT OF TWO FATAL CASES

Abstract

One case had multiple brain abscesses and fulminating meningitis from abscess rupture. Because of long-standing ulcerative colitis the colon was the probable portal of entry since no foci of infection outside the brain could be found at autopsy. Clumps of mycelia resembling debris with Gram>s stain and the ease of complete decolorizing of Nocardia asteroides in acid-fast staining caused difficulty in establishing the diagnosis. The 2d case had extensive pulmonary involvement, chest wall sinus formation and meningo- encephalitis. The diagnosis was made 3 months before death but treatment with sulfadiazine, erythromycin and oxytetracycline was ineffective. The organism was sensitive to both antibiotics. Of the 5 reported cases with central nervous system involvement, 4 had neurosurgical intervention, either excision and drainage of abscesses or ventricular drainage. It is suggested that any case with brain involvement and localizing signs should have cranial exploration.