皮疽诺卡菌感染引起脑脓肿1例报告及文献复习

目的探讨皮疽诺卡菌感染引起脑脓肿的临床、影像学、病原学表现及诊疗方法。方法回顾性分析1例皮疽诺卡菌感染引起脑脓肿患者的临床资料，并复习相关文献。结果患者男性，56岁，右足背外伤致皮肤破损，5个月后反复出现四肢无力，继持续意识不清。MRI检查示脑实质多发占位病变，增强扫描呈环形强化，DWI示病灶中央无强化区高信号，考虑为多发脑脓肿形成。行双侧枕叶、右侧额顶叶多发脓肿清除术。脓液培养、菌落质谱仪检测及血DNA高通量基因检测确定为皮疽诺卡菌感染。采用复方磺胺甲恶唑联合亚胺培南、阿米卡星治疗后患者恢复良好。结论皮疽诺卡菌感染在临床和影像学表现上无特异性；微生物病原学检测显示皮疽诺卡菌感染，对临床诊断疗起到重要作用；治疗药物首选复方磺胺甲恶唑，并且联合亚胺培南等，疗程相对要长。

Abstract： Objective To investigate the clinical, imaging, etiological manifestations, diagnosis and treatment of brain abscess caused by Nocardia farcinica. Methods The clinical data of a patient with brain abscess caused by Nocardia farcinica were analyzed retrospectively, and the relevant literature was reviewed. Results The patient was a 56 year old male with skin damage caused by trauma to the back of the right foot. After 5 months, he repeatedly had limb weakness and continued unclear consciousness. MRI showed multiple space occupying lesions in the brain parenchyma, and the enhanced scan showed circular enhancement. DWI showed no high signal in the central area of the lesion, which was considered to be the formation of multiple brain abscesses. Removal of multiple abscesses in bilateral occipital lobe and right frontoparietal lobe was performed. Purulent culture, colony mass spectrometry and high-throughput gene detection of blood DNA were identified as Nocardia farcinica. The patients recovered well after treatment with compound sulfamethoxazole combined with imipenem and amikacin. Conclusions Nocardia farcinica has no specificity in clinical and imaging manifestations; Microbiological examination shows that the infection of Nocardia farcinica can play an important role in clinical diagnosis and treatment. Compound sulfamethoxazole is the first choice for treatment combined with imipenem, and the course of treatment is relatively long.