Multiple Intracranial Nocardia brevicatena Abscesses in a Patient with a Previous History of Tuberculosis: A Case Report

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Zhaoyang Li,1,* Yuheng Zhang,1,* Xiaoming Zhang,1,* Hongchun Li,2,* Xue Gong,2,* Qian Zhang,2,* Jing Xu,2,* Xiaofeng Cheng,2,* Jinghuan Wang,2,* Tao Wang,2 Qiuxin Zhang,3 Qingwu Yang,2,4 Chenhao Zhao2 1College of Basic Medicine, Army Medical University, Chongqing, 404100, People’s Republic of China; 2Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People’s Republic of China; 3Graduate School, North Sichuan Medical College, Nanchong, Sichuan, 637002, People’s Republic of China; 4Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, 400064, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qingwu Yang, Department of Neurology, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Main Street, Shapingba District, Chongqing, People’s Republic of China, Email yangqwmlys@163.com Chenhao Zhao, Department of Neurology, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Main Street, Shapingba District, Chongqing, People’s Republic of China, Email xqyyzch@tmmu.edu.cnBackground: Nocardia brevicatena (N. brevicatena) is an uncommon cause of brain infections, frequently mistaken for intracranial tuberculosis, especially in patients with a tuberculosis (TB) history, leading to improper treatment. This case report outlines the symptoms, diagnosis, and treatment of a patient with multiple brain abscesses from N. brevicatena after laryngeal TB, highlighting the importance of next-generation sequencing (NGS) for accurate diagnosis.Case Presentation: This report details a 55-year-old man with a history of TB. Symptoms included dizziness, headache, and unsteady gait, with MRI revealing brain nodules and edema. He initially received anti-TB treatment, but it was ineffective. NGS identified N. brevicatena, and TB tests were negative. He was treated with anti-Nocardia drugs (compound sulfamethoxazole tablets (0.96 g, orally twice daily), amikacin sulfate injection (0.6 g, once daily), and imipenem-cilastatin sodium (0.5 g, every 6 hours)), leading to symptom improvement and MRI changes. Symptoms worsened when treatment was paused but resolved within a week of resuming therapy, following 45 days of treatment, the patient fulfilled the discharge criteria. After seven months, the patient fully recovered with normal MRI results.Conclusion: Intracranial N. brevicatena infections are frequently misdiagnosed as TB in patients with a TB history. NGS of blood or cerebrospinal fluid accurately detects pathogens, and TB Xpert helps rule out TB. Both are crucial for targeted treatment and better patient outcomes.Keywords: case report, Nocardia, intracranial infection

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