Cure of Brain Abscess Caused by Nocardia asteroides Resistant to Multiple Antibiotics

Abstract

A 29-year-old man with pulmonary infiltrates due to pulmonary alveolar proteinosis had Nocardia asteroides pneumonia and brain abscess. The nocardial infections persisted after therapy with sulfonamides, minocycline, and cefotaxime. Based on the susceptibility studies and serum antibiotic concentrations, he was treated with minocycline, 400 to 600 mg daily, cefotaxime, 12 to 30 gm daily, and probenecid for 15 months. Proteinuria observed near the completion of therapy was transient. Three years after therapy, the infections appear to have been cured.