Ruptured Mycotic Cerebral Aneurysm Secondary to Disseminated Nocardiosis

Masayuki Goto; Aiki Marushima; Kyoji Tsuda; Tomoji Takigawa; Wataro Tsuruta; Eiichi Ishikawa; Yuji Matsumaru; Akira Matsumura

doi:10.4103/ajns.AJNS_283_20

Ruptured Mycotic Cerebral Aneurysm Secondary to Disseminated Nocardiosis

Asian J Neurosurg. 2020 Oct 19;15(4):1072-1075. doi: 10.4103/ajns.AJNS_283_20. eCollection 2020 Oct-Dec.

Authors

Masayuki Goto¹, Aiki Marushima¹, Kyoji Tsuda¹, Tomoji Takigawa¹, Wataro Tsuruta¹, Eiichi Ishikawa¹, Yuji Matsumaru¹, Akira Matsumura¹

Affiliation

¹ Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba, Japan.

Abstract

We report a case of a ruptured mycotic cerebral aneurysm caused by Nocardia infection. A 22-year-old immunocompromised woman with adult-onset Still's disease developed a subarachnoid hemorrhage (SAH). Digital subtraction angiography revealed a small aneurysm at the M2-3 bifurcation of the right middle cerebral artery. Cardiac ultrasonography showed vegetation at the posterior cardiac wall, suspecting infective endocarditis (IE). Gram-positive filamentous bacteria were observed in the necrotic tissue surrounding the aneurysm obtained during trapping surgery. Long-term blood culture showed that the cause of her cerebral mycotic aneurysm was nocardiosis. A mycotic ruptured cerebral aneurysm is an important cause of SAH in immunocompromised patients. Early diagnosis of IE, detection of gram-positive rods by Gram staining, and long-term culture to identify the bacteria is crucial in diagnosing nocardiosis.

Keywords: Immunosuppressed host; nocardiosis; ruptured mycotic cerebral aneurysm.

Publication types

Case Reports