A 55-year old man presented with a two-day history of headache, fever and generalized weakness. He had received a cadaveric kidney transplant 5 years earlier. His medications included 5 mg of tacrolimus twice a day and 10 mg of prednisone daily. On neurologic examination, he was confused and incoherent. Cranial nerves were normal, but he had a hazy left retina. Magnetic resonance imaging of the brain with the administration of gadolinium showed multiple enhancing lesion in both cerebral hemispheres. The treatment of choice in this condition is -
Nocardiosis requires at least 6 months of treatment, preferably with trimethoprim/sulfamethoxazole or high doses of sulfonamides. In patients who do not respond to sulfonamide treatment, other drugs, such as ampicillin, erythromycin, or minocycline, may be added. Treatment also includes surgical drainage of abscesses and excision of necrotic tissue. The acute phase requires complete bed rest; as the patient improves, activity can increase. A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise Ref Davidson 23rd edition pg 712
Trimethoprim-sulfamethoxazole
Penicillin long acting
Anti tubercular therapy
Sterods
Miscellaneous