Nocardia Lymphadenitis and Encephalitis in Immunocompromised Patient: A Case Report

Abstract

Background: Nocardiosis-related HIV usually appears in immunocompromised patients, which is caused by Nocardia sp. Although a number of reports describe pulmonary forms of nocardiosis in HIV-positive patients, lymphadenitis and encephalitis due to this organism are rare entities. Our preliminary search has only found a few cases reported in the literature. Unless investigations like gram stain and culture for Nocardia are specifically done, the infection is often mistaken for tuberculosis. We have herein reported a case of Nocardia lymphadenitis and encephalitis in an HIV-positive patient. Case Presentation: A 33-year-old male presented fever, progressive weakness in the right side of the body, multiple lesions on the oral cavity, and left colli lesions. Physical examination found GCS as E4 M6 V uncounted, hypertonic and increased physiology reflexes on the right extremity without pathologic reflexes, meningeal signs, and all cranial nerves as normal. The laboratory test result was HIV-positive with CD4+ 7 cells/μL and Nocardia sp. on histopathology. A plain head computed tomography (CT) scan showed a hypodense lesion in the fronto-temporo-parieto-occipital sinistra region, and vasogenic edema. The patient was administered antiretroviral (ARV) therapy and antibiotics for nocardiosis lymphadenitis. Conclusion: A rare case of Nocardia lymphadenitis has been reported in this paper, and the physician must be aware of nocardiosis in HIV patients with neurological deficits.