A case of Nocardia brain abscess that improved after switching from a combination of sulfamethoxazole and trimethoprim to moxifloxacin hydrochloride due to worsening renal function

Abstract

  Nocardia brain abscesses are relatively rare, accounting for ～2% of all brain abscesses, but the prognosis is poor with a mortality rate is three times higher than those of other types of brain abscess. There is no established treatment, but based on past case studies, trimethoprim-sulfamethoxazole is often listed as the first choice. We recently used trimethoprim-sulfamethoxazole to treat a 72‒year‒old Japanese man who was diagnosed with a Nocardia brain abscess, but his renal function deteriorated, and the treatment was changed to moxifloxacin hydrochloride, which improved his condition. We provide the patient’s case details together with a brief review of the literature concerning Nocardia brain abscesses.