PMC9805727_01
Brain MRI and CT images pre and post surgery. (A and B) Multiloculated lesions were found with long T1-weighted and T2-weighted images in the left temporo-occipital lobe. The lesions were surrounded by large patches of edema. (C) Diffusion-weighted imaging showed high signal intensity in the center of the lesions. (D) Gadolinium-enhanced T1-weighted image demonstrated ring-enhancing lesions. (E) A CT scan one week after surgery. (F) There was no residual enhancing lesion at 4 months after surgery.
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Brain magnetic resonance imaging (MRI) revealed irregular lesions and surrounding edema in the left temporo-occipital lobe (Figure 1A and B). Enhanced diffusion-weighted imaging (DWI) signals were observed in the center of the lesions (Figure 1C). The signal intensity of the ring wall around the lesions was markedly increased after enhancement (Figure 1D). Then we performed craniotomy to excise the lesions (Figure 1E). A repeat CT confirmed total excision of the space-occupying lesions (Figure 1E). No residual lesion was observed through gadofluorine-enhanced magnetic resonance imaging (Figure 1F).
The results of staining and culture. (A) Weak acid-fast staining of the abscess wall (x1000). (B) An image of pure bacteria after 10 days of culture.
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Weak acid-fast staining showed acid-fast, branching and uneven staining of filamentous bacilli (Figure 2A), suggestive of Nocardia. mNGS analysis reported N. brevicatena with 28,770 unique reads distributing across regions of the genome (Figure 3). Specimen culturing on blood agar plates at 37 C under aerobic conditions yielded pale yellow, rough, and dry colonies (Figure 2B).
The distribution of mapping read number on the genome of N. brevicatena.
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Weak acid-fast staining showed acid-fast, branching and uneven staining of filamentous bacilli (Figure 2A), suggestive of Nocardia. mNGS analysis reported N. brevicatena with 28,770 unique reads distributing across regions of the genome (Figure 3).