CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1687102
This article is part of the Research TopicCase Reports in Intensive Care Medicine 2025View all 9 articles
Nocardia Infection: A Rare Case Report of a Cerebellar Mass
Provisionally accepted
Izzuddin Azaharuddin1
Mohammad Nizam Mokhtar1*
Chuan Hun Ding2
Mohd Imree Azmi3
Farah Hanim Abdullah1
Yik Peng Su1Affiza Zainudin2- 1Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Univerisiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- 2Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- 3Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Abstract Introduction: Central nervous system (CNS) nocardiosis is a rare but lethal opportunistic infection, presenting a formidable diagnostic and therapeutic challenge, especially in immunocompromised populations. The most common presentation is a cerebral abscess. Case Presentation: We report the case of a 53-year-old male with a history of relapsed and refractory multiple myeloma who presented with an acute change in mental status and ataxia. Initial clinical suspicion centered on a posterior circulation ischemic event. However, magnetic resonance imaging (MRI) revealed a large, rim-enhancing cerebellar mass with associated obstructive hydrocephalus. The patient underwent surgical excision of the lesion, and subsequent microbiological culture confirmed an abscess caused by a Nocardia species. He was successfully treated with a prolonged course of targeted antimicrobial therapy, including intravenous imipenem, followed by oral linezolid and trimethoprim-sulfamethoxazole. At the 3-month outpatient follow-up after discharge, the patient was found to have thrombocytopenia, attributed to the side effects of oral trimethoprim-sulfamethoxazole. Treatment was subsequently maintained with oral linezolid 600 mg for one year. Despite improvement of the abscesses, the patient ultimately succumbed to the progression of his long-standing multiple myeloma.The patient demonstrated significant neurological improvement and was discharged in stable condition. Conclusion: This case underscores the importance of including uncommon opportunistic pathogens like Nocardia in the differential diagnosis of CNS lesions in immunocompromised patients. A definitive diagnosis via microbiological analysis of tissue specimens is imperative to guide appropriate antimicrobial therapy and achieve a favourable clinical outcome.
Keywords: Nocardia, Abscess, Central Nervous System, immunocompromise, Cerebellar mass
Received: 16 Aug 2025; Accepted: 19 Sep 2025.
Copyright: © 2025 Azaharuddin, Mokhtar, Ding, Azmi, Abdullah, Su and Zainudin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mohammad Nizam Mokhtar, drnizam@ukm.edu.my
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