trimethoprim--sulfamethoxazole-drug-combination and Cauda-Equina-Syndrome

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.

Topics: Adult; Anti-Bacterial Agents; Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Humans; Laminectomy; Low Back Pain; Magnetic Resonance Imaging; Male; Meropenem; Nocardia; Nocardia Infections; Paraplegia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination