Acute spinal cord compression caused by disseminated Nocardia infection involving the conus medullaris

• Published in: Clinical neurology and neurosurgery Vol. 112; no. 8; pp. 726 - 728
• Main Authors: Stokes, M.B, Reardon, K.A, O’Day, J
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2010; Elsevier Limited
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Cauda Equina - pathology; Compression; Conus; Diagnosis, Differential; Disseminated; Female; Gram-positive bacteria; Humans; Immunosuppressed; Infection; Infections; Kinases; Medical diagnosis; Nerve Compression Syndromes - drug therapy; Nerve Compression Syndromes - microbiology; Nerve Compression Syndromes - pathology; Neurology; Neurosurgery; Nocardia asteroides; Nocardia cyriacigeorgica; Nocardia Infections - complications; Nocardia Infections - diagnosis; Nocardia Infections - drug therapy; Opportunistic Infections - diagnosis; Opportunistic Infections - microbiology; Organisms; Polyradiculopathy - drug therapy; Polyradiculopathy - microbiology; Polyradiculopathy - pathology; Spinal Cord - microbiology; Spinal Cord - pathology; Spinal Cord Compression - drug therapy; Spinal Cord Compression - microbiology; Spinal Cord Compression - pathology; Spinal Cord Neoplasms - pathology; Substance abuse treatment; Treatment Outcome; Infection; Immunosuppressed; Disseminated; Conus; Nocardia cyriacigeorgica
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2010.05.009

Abstract Distinguishing between an infective and malignant process provides a diagnostic challenge for clinicians. This case highlights an example of an acute spinal cord compression that could fall into either of these two categories. The diagnosis in this case of disseminated Nocardiosis is an extremely rare cause of acute spinal cord compression and to our knowledge intrinsic conus medullaris infection from Nocardia has not previously been reported in the literature. Nocardia cyriacigeorgica is an emerging strain of Nocardia species recently identified which was previously categorised as Nocardia asteroides type VI infection. The challenge of eliciting the diagnosis and the need to have an index of suspicion of Nocardia as a possible aetiology agent is shown in the report. The case shows this is especially important in evaluation of a multi-system infection in an immunosuppressed individual. The case described highlights an interesting diagnostic case with the resultant causative organism an emerging strain of Nocardia species with no previous reported cases of conus medullaris involvement.