Reversible personality changes caused by brain nocardiosis in a 74-year old Caucasian male renal transplant recipient following disease-specific antimicrobial therapy

The management of potentially life-threatening brain nocardiosis in an elderly renal transplant recipient with the relevant specific antimicrobial agents while still continuing anti-rejection immunosuppressive therapy poses major clinical, pharmaceutical and logistical problems. This is a case of a 70-plus year old Caucasian male renal transplant recipient on maintenance immunosuppression, who developed a left flank abscess that was later complicated by the onset of personality changes from brain nocardiosis. The evolution of the diagnosis, treatment and recovery in this case presentation highlight the need for microbial susceptibility testing, the need for pharmacovigilance to monitor drug intolerance and drug resistance as well as other overarching treatment strategies including a close collaboration between Infectious Diseases and Transplant Medicine specialties in the management of this complicated case.