Intracranial Nocardiosis: A Review of 21 Cases

Abstract

Abstract Introduction Nocardiosis is a bacterial infection predominantly seen in immunocompromised hosts, with patients mainly presenting with pulmonary involvement. Intracranial involvement is rare and is thought to be associated with high mortality. Aim This study aims to evaluate the imaging appearance of intracranial nocardiosis and to assess clinical outcomes. Setting and Design In this retrospective study, 21 patients with intracranial nocardiosis were identified between 2009 and 2023 in a single tertiary care hospital in South India. The patient charts and imaging were assessed, and various radiological findings were documented. Clinical and imaging follow-up was also assessed. Results Four patterns of involvement were seen: large abscesses, smaller abscesses, ring-enhancing lesions, and meningitis. Clinical and radiological discordance was observed, with the Glasgow Coma Scale being normal in the majority of patients despite intracranial abscesses. The presence of lung involvement was common. Mortality was 9.5%, which is low compared to the literature, with good clinical outcomes on follow-up. Conclusion Mortality with intracranial nocardiosis was found to be lower than reported in literature. Pulmonary disease, in the presence of intracranial abscess and immunocompromised status, should raise concerns about nocardial infection.