Abstract
INTRODUCTION: Norcardosis is a rare infection most frequently caused by the gram positive, acid-fast bacteria Norcardia Asteroides. The lungs and skin are the most commonly affected organs though cerebral infection is a complication of 15–40% of systemic norcardiosis. Here, the first case is reported of the diagnosis of Glioblastoma Multiforme being delayed due to the distraction from the accompanying Norcardiosis Case Report: In October 2015, a 65-year-old man with a background of previous DVT and bilateral pulmonary embolisms presented to the University Hospitals Coventry and Warwickshire (UHCW) with a 3 day history of worsening headache. Imaging revealed multiple ring enhancing lesions in the deep right temporal lobe, right frontal, both parietal lobes and cerebellum. Post operative histology samples suggested a diagnosis of Norcardia for which he received Co-trimoxazole and Linezolid. However, previously excised lesions re-appeared, old lesions progressed and new lesions developed requiring multiple re-visits to the operating room. Histology samples indicated an infective process until the 5th intra-operative sample grew Glioblastoma WHO grade 4. The patient received a sixth operation and currently remains on antibiotic therapy. He is responding well and is neurologically intact. DISCUSSION: There are few cases of an intracerebral neoplasm being colonated by Norcardia. The literature suggests that various techniques using MR perfusion, diffusion imaging and spectroscopy are useful in differentiating tumours from abscesses however, there is no guarantee that when both pathologies co-exist differentiation is possible. Further studies are needed to evaluate this.