RESUMO
Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.
Assuntos
Antibacterianos/uso terapêutico , Síndrome da Cauda Equina/microbiologia , Cauda Equina/efeitos dos fármacos , Dor Lombar/microbiologia , Nocardiose/microbiologia , Paraplegia/microbiologia , Adulto , Cauda Equina/diagnóstico por imagem , Cauda Equina/microbiologia , Cauda Equina/cirurgia , Síndrome da Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/tratamento farmacológico , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Dor Lombar/cirurgia , Imageamento por Ressonância Magnética , Masculino , Meropeném/uso terapêutico , Nocardia/efeitos dos fármacos , Nocardia/crescimento & desenvolvimento , Nocardia/patogenicidade , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Paraplegia/diagnóstico por imagem , Paraplegia/tratamento farmacológico , Paraplegia/cirurgia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Spontaneous (nontraumatic, nonsurgical) cerebrospinal fluid (CSF) rhinorrhea constitute only 3-4% of all cases. Here, we present a case of a 66-year-old male who presented with spontaneous CSF rhinorrhea, where intraoperative findings revealed an anterior clival defect as the cause. Such cases are extremely rare, and to the best of our knowledge only five of such cases are described in the literature. In this report, we discuss the possible etiology and management of this rare condition.