422 - Rehabilitation in the Setting of Intracranial Nocardia Farcinica Abscesses: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JM

Jessica V. Marone, MD

Resident Physician
Northwestern/Shirley Ryan AbilityLab
Chicago, Illinois, United States

Co-Author(s)

DC

David Civitarese, DO

Resident Physician
Northwestern/Shirley Ryan AbilityLab
Chicago, Illinois, United States
HB

Hollis Bell, MD

Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States

Case Diagnosis: Intracranial Nocardia farcinica abscesses

Case Description: A 64-year-old previously independent man on chronic steroids presented to acute care with word finding difficulty and left upper extremity weakness. Physical exam demonstrated non-fluent aphasia, left hemiparesis, and upper motor neuron signs. Brain imaging demonstrated multiple cystic, rim-enhancing lesions at the right cerebrum with surrounding edema. A brain biopsy was obtained and revealed Nocardia farcinica. Surgical drainage was performed, and antibiotics and steroids were administered. The patient was discharged to acute inpatient rehabilitation where he was initially noted to require dependent assistance for the majority of activities of daily living (ADL’s) and ambulation and to require moderate assistance for transfers. The patient underwent three weeks of intensive physical, occupational and speech therapy. By discharge, the patient was able to complete all ADL’s, ambulation, and transfers at an independent level.

Discussions: Norcardia abscesses are rare, and reported to account for less than 2% of all intracranial abscesses. Nocardia species are considered opportunistic pathogens that primarily affect the pulmonary system, though can disseminate to the skin and central nervous system. Nocardia farcinica specifically is rarely implicated in Nocardia infections. Despite its relative rarity, N.farcinica has been noted to be more virulent and display a high degree of antibiotic resistance than other species of Nocardia. Of note, mortality rates of N. farcinica infections are reported to be as high as 30%.

Conclusions: Here, we report a case of Nocardia farcinica cerebral abscesses resulting in neurological impairments and associated functional limitations. Importantly, the patient demonstrated robust functional recovery, likely due to infection and edema management in tandem with intensive rehabilitation. This report is intended to make the clinician aware of this rare diagnostic entity, and demonstrate the utility of rehabilitation in this patient population.