Nocardial Vertebral Osteomyelitis and Epidural Abscess of Thoracic Spine in an Immunocompromised Patient

Vertebral osteomyelitis and epidural abscess caused by Nocardia brasiliensis is very rare. This report states the successful treatment of Nocardial vertebral osteomyelitis and epidural abscess of the thoracic spine. A 56-year-old Thai female presented with pulmonary nocardiosis and sudden paraplegia. Her underlying disease was Evans syndrome (immunocompromised host). Her physical examination and investigation showed vertebral osteomyelitis and a spinal epidural abscess, which was compressing her spinal cord (T4- T7). Culture pus and tissue specimens from the epidural spine were reported as Nocardia brasiliensis. The patient underwent standard treatment for vertebral osteomyelitis and epidural abscess by surgical decompression, debridement and prolonged antibiotic therapy with intravenous Bactrim (trimethoprimsulfamethoxazole (TMP-SMX)) for a total of 2 weeks, and then continued with oral Bactrim for 12 months. The patient’s neurological status had significantly improved at a 12-month follow-up. Nocardia brasiliensis osteomyelitis and epidural abscess are very challenging in their management. However, early investigation for diagnosis, followed by medical and surgical treatment they can have a successful outcome.