Brain abscesses are focal suppurative processes associated with high morbidity and mortality, most commonly caused by Streptococcus or Staphylococcus species. Infection by Nocardia spp. is an uncommon etiology (1–2 %), predominantly opportunistic and associated with hematogenous dissemination from pulmonary foci. Clinically, these lesions are most frequently located in supratentorial regions, whereas cerebellar involvement is unusual, particularly in immunocompetent patients. We present the case of a 43-year-old immunocompetent male with a history of recurrent pulmonary infections and a prior frontal abscess. The patient developed a posterior fossa cerebellar abscess, presenting with headache, seizures, and ataxia. Following suboccipital craniectomy, histopathological and microbiological studies confirmed Nocardia farcinica . Comprehensive management through surgical resection and targeted antibiotic therapy (meropenem and trimethoprim/sulfamethoxazole) resulted in favorable clinical recovery. This case highlights the rarity of cerebellar abscesses caused by Nocardia species in immunocompetent patients. Although these lesions are typically supratentorial, posterior fossa involvement represents a significant and severe clinical presentation. The importance of maintaining a high index of diagnostic suspicion in the presence of cystic or multifocal intracranial lesions is emphasized, regardless of the patient’s immune status. Surgical resection combined with prolonged antibiotic therapy constitutes the cornerstone of treatment to optimize prognosis and reduce the high mortality associated with this entity. Category: Pathology, neurosurgery
Castillo et al. (Mon,) studied this question.