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Abstract #109834 Published in IGR 24-1
Occipital Nocardia Abscess Presenting With Positive Visual Phenomenon and Quadrantanopsia
Fein AS; Kelly SM; Louie E; Young MG; Jain R; William CM; Galetta SL; Grossman SNJournal of Neuro-Ophthalmology 2023; 43: 430-433
A 74-year-old man with chronic obstructive pulmonary disease, glaucoma, and Stage IIIB squamous cell lung cancer experienced several minutes of flashing lights in his right visual hemifield, followed by onset of a right visual field defect. On examination, the patient had a right homonymous hemianopsia that was most dense inferiorly by confrontation testing. Emergent CT scan of the head revealed a 2.5 × 3 cm hypodensity in the left occipital lobe, which was interpreted as an acute stroke. Continuous EEG monitoring captured left posterior quadrant seizures that were temporally correlated to the positive visual phenomena. Subsequent MRI of the brain with and without contrast revealed a conglomerate of centrally necrotic and peripherally enhancing mass lesions. On biopsy, a thick purulent material was drained and Gram stain of the sample revealed gram-positive beaded rods, which speciated to Nocardia farcinica . The patient was treated with a six-week course of intravenous meropenem and a one-year course of oral trimethroprim-sulfamethoxazole. On follow-up, the patient experienced resolution of the right visual field deficit.
Department of Neurology (ASF, SMK, SLG, SNG), New York University Grossman School of Medicine, New York, New York; Division of Infectious Diseases (EL), Department of Medicine, New York University Grossman School of Medicine, New York, New York; and Departments of Radiology (MGY, RJ) and Department of Pathology (CMW), New York University Grossman School of Medicine, New York, New York.
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