Nocardial spinal epidural abscess with lumbar disc herniation: A case report and review of literature

Lumpy jaw caused by Nocardia farcinica in a Holstein cow

A 3-year-old Holstein cow was examined in an intensive system due to unilateral swelling in the mandible. A right mandibular mass was associated with painful mastication and Ptyalism. In palpation, the mass was raised, ulcerated, attached to the mandible bone and firm, approximately 17 × 12 × 10 cm3 in size. The lesion was sampled, and after routine bacteriology and histopathology procedures, the occurrence of lumpy jaw caused by Nocardia farcinica was confirmed. The bacterium was analysed using genome sequencing and new strain called Najm 114. Due to the risk of zoonosis of the isolated agent, the cow was euthanized. This is the first report of lumpy jaw caused by N. farcinica in a cow. This study showed that N. farcinica should be considered a possible etiological agent for lumpy jaw in cattle.

Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature

Background

Nocardia is a relatively rare opportunistic pathogenic bacteria group, commonly seen in patients with immunocompromised or defective immune system. It can affect multiple organs of the body and cause disseminated infection, among which most occurs in the lung, secondly in the nervous system, soft tissues, rare in the spinal cord and pituitary. No case has been reported involving lung, spinal cord, skin and pituitary gland at the same time.

Case presentation

We report a 55-year-old female with Nocardia infection involving the lung, skin, spinal cord, and pituitary gland. The patient underwent a full set of imaging examinations and showed typical imaging findings. Chest computed tomography (CT) showed multiple nodules with cavities in the lungs. The magnetic resonance imaging (MRI) of the vertebral body showed abnormal signal of the entire spinal cord with cavity formation and ring enhancement. The subcutaneous nodules of the abdomen were punctured under ultrasound. Through the etiological tissue culture of subcutaneous nodules and the second generation sequencing of cerebrospinal fluid, the diagnosis was finally confirmed.

Conclusion

Disseminated Nocardiosis is an uncommon disease. This article will report a rare case of disseminated Nocardiosis simultaneously involving the lung, spinal cord, subcutaneous soft tissue and pituitary gland, especially with neuropathy as the initial symptom. Imaging is helpful for the early diagnosis of the disease and pathological and microbiological examinations are helpful for its confirming.

A rare disease mimicking lung cancer

We present an interesting case of a 34 year old gentleman with bilateral FDG avid lesions in the apex of the lung. He presented with a two month history of cough, fever and hemoptysis. A contrast enhanced CT scan showed a spiculated lesion in the right upper lobe. A CT guided biopsy was done which was suggestive of an inflammatory lesion. He was started empirically on anti tubercular therapy, but his symptoms did not subside. A PET CT scan was done, which showed the lesion to be FDG avid. A repeat biopsy was done and again it was reported as an inflammatory infiltrate. He was then referred to our center for a surgical biopsy. We repeated a PET scan and were surprised to find another lesion in the apex of the opposite lung. The case was discussed with our interventional pulmonogy team and an EBUS guided biopsy of the lesion was done. On microbiological analysis the specimen was found to be positive for Nocardia.

Percutaneous transforaminal endoscopic discectomy for the treatment of lateral recess stenosis secondary occurred the discal fungus infection

Background

This is a case of lateral recess stenosis secondary occurred the discal fungus infection treated with percutaneous transforaminal endoscopic discectomy (PTED). There has been no relevant reports before.

Case presentation

A 49-year-old patient who had taken itraconazole for 13 months for lateral recess stenosis secondary occurred the discal fungus infection complained of gradually worsening radiating pain and numbness in the back and inguinal and inner thigh region of right side. In order to relieve the radiating neuralgia and reduce the damage to spinal stability, the minimally invasive PTED was performed.The patient’s prognosis was assessed using Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS).

During the follow-up, the patient’s ODI and VAS scores were decreased significantly. The radiating pain in the inguinal and inner thigh region of right side were significantly alleviated and the discomfort caused by lower back instability was improved by plaster vest.

Discussion and conclusion

PTED not only avoids further damage to the stability of the lumbar spine, but also effectively relieves the symptoms of leg neuroradialgia caused by lateral recess stenosis secondary occurred the discal fungus infection.