trimethoprim--sulfamethoxazole-drug-combination and Cerebellar-Diseases

A 71-year-old woman presented with suspected tuberculosis. She reported having productive coughs, unwanted weight loss and subfebrile temperature in the preceding 3 months. She was known to have chronic obstructive pulmonary disease treated with corticoids given systemically and by inhalation. She was a heavy smoker.. Computed tomography revealed a left apical lung abscess. In the further course of the disease magnetic resonance imaging of the head demonstrated multiple abscesses in both cerebral hemispheres and an abscess, 3.4 cm in diameter, in the right side of the cerebellum, as well as a intra-orbital tumor on the right. Needle aspirate of the eyeball grew Nocardia farcinica.. Over 3 weeks antimicrobial treatment was given with imipenem and amikacin, followed by oral cotrimoxazole for 12 months. The abscesses completely regressed and after 12 months no recurrence was demonstrated either radiologically or clinically.. Although nocardiasis is rare in Germany it must be included in the differential diagnosis of pneumonia with abscesses. This is especially so if acid-fast bacilli are found. As the resistance pattern of N. farcinica to antibiotics varies, early treatment is essential with antibiotics to which it is sensitive.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Biopsy, Needle; Brain Abscess; Cerebellar Diseases; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Imipenem; Lung Abscess; Magnetic Resonance Imaging; Nocardia Infections; Orbital Diseases; Pneumonia, Bacterial; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In a case of pediatric Whipple disease confined to the central nervous system, white matter lesions initially appeared as areas of very low signal intensity on T1-weighted MR images and as areas of hyperintensity on proton density-weighted and T2-weighted images, and showed slight peripheral enhancement on delayed contrast-enhanced T1-weighted images. On MR studies obtained 3 and 6 months after antibiotic therapy, the lesions had decreased in size and no longer enhanced. They became progressively less hypointense on T1-weighted images and less hyperintense on T2-weighted images.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Brain Diseases; Cerebellar Diseases; Child, Preschool; Chloramphenicol; Contrast Media; Follow-Up Studies; Gliosis; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Necrosis; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease