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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 1072-1075
DOI: 10.4103/ajns.AJNS_283_20
Case Report

Ruptured mycotic cerebral aneurysm secondary to disseminated nocardiosis

Masayuki Goto
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Aiki Marushima
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Kyoji Tsuda
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Tomoji Takigawa
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Wataro Tsuruta
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Eiichi Ishikawa
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Yuji Matsumaru
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
,
Akira Matsumura
Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba
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We report a case of a ruptured mycotic cerebral aneurysm caused by Nocardia infection. A 22-year-old immunocompromised woman with adult-onset Still's disease developed a subarachnoid hemorrhage (SAH). Digital subtraction angiography revealed a small aneurysm at the M2-3 bifurcation of the right middle cerebral artery. Cardiac ultrasonography showed vegetation at the posterior cardiac wall, suspecting infective endocarditis (IE). Gram-positive filamentous bacteria were observed in the necrotic tissue surrounding the aneurysm obtained during trapping surgery. Long-term blood culture showed that the cause of her cerebral mycotic aneurysm was nocardiosis. A mycotic ruptured cerebral aneurysm is an important cause of SAH in immunocompromised patients. Early diagnosis of IE, detection of gram-positive rods by Gram staining, and long-term culture to identify the bacteria is crucial in diagnosing nocardiosis.

Key-words:

Immunosuppressed host - nocardiosis - ruptured mycotic cerebral aneurysm

Financial support and sponsorship

Japan Society for the Promotion of Science KAKENHI Grant-in-Aid for Scientific Research (C) No. JP17K10819, and Grant-in-Aid for Scientific Research (B) No. 20H03787.




Publication History

Received: 26 February 2020

Accepted: 01 September 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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