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Year : 2020  |  Volume : 15  |  Issue : 4  |  Page : 1072-1075

Ruptured mycotic cerebral aneurysm secondary to disseminated nocardiosis

Department of Neurosurgery, University of Tsukuba Hospitals, Tsukuba, Japan

Correspondence Address:
Dr. Aiki Marushima
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575
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Source of Support: Japan Society for the Promotion of Science KAKENHI Grant-in-Aid for Scientific Research (C) No. JP17K10819, and Grant-in-Aid for Scientific Research (B) No. 20H03787, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_283_20

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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.

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