Case Report: Multiple brain abscess-like lesions with concurrent detection of Nocardia amamiensis and Leishmania infantum in cerebrospinal fluid
- 1Department of Neurology, The First Affiliated Hospital of Henan University of Science and Technology , , ,
Abstract
Central nervous system nocardiosis is rare and potentially life-threatening, and human infection due to Nocardia amamiensis has seldom been reported; central nervous system involvement in visceral leishmaniasis is likewise uncommon. We report a 69-year-old man who developed progressive impairment of consciousness and coma after recurrent fever. Brain magnetic resonance imaging revealed multiple abscess-like lesions in both cerebral hemispheres, the cerebellum, and the brainstem, accompanied by acute or subacute cerebral infarctions. The cerebrospinal fluid opening pressure was 300 mmH ₂ O. The white blood cell count was 285 × 10 ⁶ /L, with 81.9% polymorphonuclear cells; protein was 1.977 g/L and glucose was 2.34 mmol/L. MetaCAP analysis of cerebrospinal fluid concurrently detected N. amamiensis and L. infantum , and bone marrow smear demonstrated Leishmania amastigotes within macrophages. The patient tested negative for human immunodeficiency virus, and abdominal ultrasonography showed no hepatosplenomegaly. On the available evidence, visceral leishmaniasis was established and central nervous system nocardiosis was strongly suspected. Detection of L. infantum in cerebrospinal fluid supported possible central nervous system involvement, but did not establish a direct contribution to the brain abscess-like lesions. The patient received trimethoprim-sulfamethoxazole, imipenem-cilastatin, amikacin, and liposomal amphotericin B, but his condition continued to deteriorate. He was discharged against medical advice, and follow-up revealed that he had died. This case illustrates that sequencing-based detection is an important clue but cannot replace culture, pathogen-specific polymerase chain reaction, or evidence from lesion tissue.
Related
- Comparative Detection of IDH1 R132H and TERT Promoter Mutations in Plasma and Cerebrospinal Fluid of Patients with Glioma Using Targeted Droplet Digital PCR
- PCR Detection and Species Identification of Leishmania in Microscopy-Negative Smears from Suspected Cutaneous Leishmaniasis in Iran
- Cerebrospinal fluid positive for SARS-CoV-2 associated with neurological manifestations and proteome alterations in a multiple myeloma patient.
- First detection of Leishmania infantum in dogs and wild-caught Culicoides oxystoma in Hainan Province, Southern China.
- Urine-based detection of Leishmania donovani antibodies using recombinant aurora kinase and otubain cysteine peptidase for noninvasive diagnosis of visceral leishmaniasis
BibTeX
@article{liang2026case,
title = {{Case Report: Multiple brain abscess-like lesions with concurrent detection of Nocardia amamiensis and Leishmania infantum in cerebrospinal fluid}},
author = {Jiahao Liang and Gang Wang and Ruile Shen},
journal = {Frontiers in immunology},
year = {2026},
month = sep,
doi = {10.3389/fimmu.2026.1881701},
url = {https://europepmc.org/article/PMC/PMC13661340},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Multiple brain abscess-like lesions with concurrent detection of Nocardia amamiensis and Leishmania infantum in cerebrospinal fluid
AU - Jiahao Liang
AU - Gang Wang
AU - Ruile Shen
PY - 2026
DA - 2026/09/30
JO - Frontiers in immunology
DO - 10.3389/fimmu.2026.1881701
UR - https://europepmc.org/article/PMC/PMC13661340
AB - Central nervous system nocardiosis is rare and potentially life-threatening, and human infection due to Nocardia amamiensis has seldom been reported; central nervous system involvement in visceral leishmaniasis is likewise uncommon. We report a 69-year-old man who developed progressive impairment of consciousness and coma after recurrent fever. Brain magnetic resonance imaging revealed multiple abscess-like lesions in both cerebral hemispheres, the cerebellum, and the brainstem, accompanied by acute or subacute cerebral infarctions. The cerebrospinal fluid opening pressure was 300 mmH ₂ O. The white blood cell count was 285 × 10 ⁶ /L, with 81.9% polymorphonuclear cells; protein was 1.977 g/L and glucose was 2.34 mmol/L. MetaCAP analysis of cerebrospinal fluid concurrently detected N. amamiensis and L. infantum , and bone marrow smear demonstrated Leishmania amastigotes within macrophages. The patient tested negative for human immunodeficiency virus, and abdominal ultrasonography showed no hepatosplenomegaly. On the available evidence, visceral leishmaniasis was established and central nervous system nocardiosis was strongly suspected. Detection of L. infantum in cerebrospinal fluid supported possible central nervous system involvement, but did not establish a direct contribution to the brain abscess-like lesions. The patient received trimethoprim-sulfamethoxazole, imipenem-cilastatin, amikacin, and liposomal amphotericin B, but his condition continued to deteriorate. He was discharged against medical advice, and follow-up revealed that he had died. This case illustrates that sequencing-based detection is an important clue but cannot replace culture, pathogen-specific polymerase chain reaction, or evidence from lesion tissue.
SN - 1664-3224
ER -