{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:01:11Z","timestamp":1753891271701,"version":"3.41.2"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>A middle-aged man, renal transplant recipient, was admitted with lower extremity paralysis, loss of sensation and urinary retention. The initial diagnostic workup revealed extensive inflammatory spinal changes on imaging, consistent with longitudinally extensive transverse myelitis. Cerebrospinal fluid testing demonstrated neutrophilic pleocytosis; routine tests for bacterial and viral pathogens were negative. The patient received high-dose steroids for presumed autoimmune myelitis, but his condition worsened. Repeat spinal imaging revealed an intramedullary spinal cord abscess and a loculated collection in the cauda equina. <jats:italic>Nocardia farcinica<\/jats:italic> was isolated from spinal biopsy tissue cultures and metagenomic sequencing of cerebrospinal fluid. He received treatment with trimethoprim-sulfamethoxazole and linezolid, with subsequent improvement of the radiological abnormalities. At outpatient follow-up two months after initiating antimicrobials, the patient endorsed improved upper extremity strength, though remained paraplegic. This case report highlights the protean manifestations of central nervous system nocardiosis and the benefits of using metagenomic sequencing to diagnose complex central nervous system infections.<\/jats:p>","DOI":"10.3389\/fmed.2025.1613770","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T05:29:47Z","timestamp":1749101387000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Spinal cord abscess due to Nocardia farcinica presenting as longitudinally extensive transverse myelitis"],"prefix":"10.3389","volume":"12","author":[{"given":"Tayoot","family":"Chengsupanimit","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelli","family":"Farhadian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Machiavello Roman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1038\/nrneurol.2011.176","article-title":"Longitudinal extensive transverse myelitis--it\u2019s not all neuromyelitis optica","volume":"7","author":"Trebst","year":"2011","journal-title":"Nat Rev Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1177\/1352458511406165","article-title":"The differential diagnosis of longitudinally extensive transverse myelitis","volume":"18","author":"Kitley","year":"2012","journal-title":"Mult Scler"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e13509","DOI":"10.1111\/ctr.13509","article-title":"Nocardia infections in solid organ transplantation: guidelines from the infectious diseases community of practice of the american society of transplantation","volume":"33","author":"Restrepo","year":"2019","journal-title":"Clin Transpl"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e13025","DOI":"10.1111\/tid.13025","article-title":"An unusual case of nocardia cyriacigeorgica presenting with spinal abscesses in a renal transplant recipient and a review of the literature","volume":"21","author":"Freiberg","year":"2019","journal-title":"Transpl Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1128\/CMR.7.2.213","article-title":"Nocardia species: host-parasite relationships","volume":"7","author":"Beaman","year":"1994","journal-title":"Clin Microbiol Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1086\/514340","article-title":"Risk factors, clinical characteristics, and outcome of nocardia infection in organ transplant recipients: a matched case-control study","volume":"44","author":"Peleg","year":"2007","journal-title":"Clin Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/cid\/ciw241","article-title":"Nocardia infection in solid organ transplant recipients: a multicenter european case-control study","volume":"63","author":"Coussement","year":"2016","journal-title":"Clin Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"3522","DOI":"10.1038\/s41591-024-03275-1","article-title":"Seven-year performance of a clinical metagenomic next-generation sequencing test for diagnosis of central nervous system infections","volume":"30","author":"Benoit","year":"2024","journal-title":"Nat Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1425655","DOI":"10.3389\/fmed.2024.1425655","article-title":"Case report: metagenomic next-generation sequencing for the diagnosis of rare Nocardia aobensis infection in a patient with immune thrombocytopenia","volume":"11","author":"Liang","year":"2024","journal-title":"Front Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"894678","DOI":"10.3389\/fcimb.2022.894678","article-title":"Metagenomic next-generation sequencing provides prognostic warning by identifying mixed infections in nocardiosis","volume":"12","author":"Jiao","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"10120","DOI":"10.12998\/wjcc.v10.i28.10120","article-title":"Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing: a case report and review of literature","volume":"10","author":"Li","year":"2022","journal-title":"World J Clin Cases"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3389\/fcimb.2020.00013","article-title":"Rapid detection of nocardia by next-generation sequencing","volume":"10","author":"Weng","year":"2020","journal-title":"Front Cell Infect Microbiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1613770\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T05:29:48Z","timestamp":1749101388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1613770\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,5]]},"references-count":12,"alternative-id":["10.3389\/fmed.2025.1613770"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1613770","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,6,5]]},"article-number":"1613770"}}