Open AccessRuptured mycotic cerebral aneurysm secondary to disseminated nocardiosis
Author(s) -
Masayuki Goto,
Aiki Marushima,
Kyoji Tsuda,
Tomohiro Takigawa,
Wataro Tsuruta,
Eiichi Ishikawa,
Yuji Matsumaru,
Akira Matsumura
Publication year - 2020
Publication title -
asian journal of neurosurgery
Language(s) - Uncategorized
Resource type - Journals
ISSN - 2248-9614
DOI - 10.4103/ajns.ajns_283_20
Subject(s) - mycotic aneurysm , medicine , aneurysm , endocarditis , nocardiosis , infective endocarditis , digital subtraction angiography , subarachnoid hemorrhage , blood culture , gram staining , nocardia , radiology , angiography , surgery , bacteria , microbiology and biotechnology , antibiotics , genetics , biology
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.