Disseminated Prostatic Abscess to Brain and Spine

A 62-year-old male who was a known case of nephrotic syndrome and was on maintenance steroids was admitted to Max Super Speciality Hospital, Mohali, with complaints of fever, chills and urinary retention. 
The patient was catheterised and started on IV antibiotics. Bogginess was found in the right prostatic lobe on digital rectal examination. On further evaluation with multiparametric MRI prostate, he was found to have a 4x 5 cm prostatic abscess in the peripheral zone in the right lobe. 

The next day, the patient developed left lower limb weakness and drowsiness. MRI brain and spine showed multiple hyperintense areas in subcortical white matter in bilateral cerebral parenchyma and D8, D7 and D7 vertebral bodies with extension into posterior neural elements – metastatic/ neoplastic aetiology, respectively. To differentiate between  metastatic and infectious etiology, stereotactic biopsy was done. Also, TRUS-guided prostatic aspiration was done. In all culture sensitivity reports, nocardia infection was reported, which is the rarest type of causative agent ever reported in the literature so far. Following this,the patient was started on oral antibiotics twice a day and IV imipenem once a day.

Nocardia infection (nocardiosis) is a disorder that affects the lungs, brain, or skin. In otherwise healthy people, it may occur as a local infection. But in people with weakened immune systems, it may spread throughout the body. This infection is caused by a bacterium and usually starts in the lungs. It may spread to other organs, most often the brain and the skin. It may also involve the kidneys, joints, heart, eyes, and bones. Nocardia bacteria are found in soil around the world. You can get the disease by breathing the dust that has the bacteria. You can also get the disease if soil containing nocardia bacteria gets into an open wound. You are more likely to get this infection if you have long-term (chronic) lung disease or a weakened immune system,  which can occur with transplants, cancer, HIV/AIDS, and long-term use of steroids.

He responded so well that he was almost asymptomatic after 48 hours. In a repeat scan, the number of brain & spine lesions decreased significantly, and the prostatic abscess subsided as well. The patient was discharged in stable and satisfactory condition after one week.