[Nocardia brain abscess: a case report (author's transl)].

A 42 years old woman was noticed to have an abnormal shadow in the left lower field of lung at the time of periodical chest radiographic examination in July 1979. She didn't show any signs or symptoms of inflammation such as fever, increased rate of blood sedimentation, leukocytosis and so on by that time. Four weeks prior to admission she started to complain of mild but continuous headache and then developed anorexia, dysarthria and weakness in the right half of the face. She was admitted to the Kyoto University Hospital on September 14, 1979. On admission, slight bilateral papilledema, right hemiparesis and total dysphasia were present. She was afebrile and no abnormal finding in serological examination was shown. A heterogenously enhanced mass was demonstrated by CT scan in the left posterior frontal lobe, which was surrounded by severe cerebral edema. A provisional diagnosis of metastatic tumor from the lung was made. At the time of craniotomy, an abscess cavity was found and aspirated. Then the radical extracapsular ablation and external decompression was carried out. Histologically many Nocardia species were identified in the abscess cavity. The patient was treated by administration of a mixture of trimethoprine and sulfamethixazole (Bakter), and minocycline. Subsequently the developed Corynebacterial epidural empyema which was successfully evacuated two months after the first operation. She had been placed on Baktar for ten months since the second operation. She presented no sign of recurrence in six months after the cessation of drugs.