Slowly Evolving Brain Abscess Caused By Nocardia Beijingensis In A Kidney Transplant Patient

A 71-year-old actively working farmer was admitted because of progressive weakness of the left hand and leg starting 5 weeks before admission. He has been suffering from headaches in the last 4 years. He has undergone kidney transplantation 14 years before admission. Brain magnetic resonance imaging (MRI) revealed a right frontoparietal hypodense lesion measuring 22 x 34 x 17 mm, causing edema, suspected to represent an abscess. Reviewing 2 brain MRI scans performed 4 years 10 months before admission showed a gradually worsening pathological process in the same region. Open surgery revealed an abscess, and drainage was performed. Gram stain and culture from the pus were negative, but panbacterial polymerase chain reaction was positive for Nocardia beijingensis. The patient was treated with ceftriaxone and linezolid for 3 months followed by trimethoprim-sulfamethoxazole. Repeated MRI 2 weeks after drainage showed reduction in abscess size. Brain computed tomography 3 months later showed further improvement. The patient has never recovered and died 8 months later.