• Hongmei Ma, Xiangbo Wang, Heli Yan, Qing Liu, Dan Yang, and Tingting Bian.
• Department of Neurology, Beijing Fengtai You'anmen Hospital, BeijingChina.
• Medicine (Baltimore). 2022 Sep 2; 101 (35): e30325.

RationaleIntracranial infections are associated with high morbidity and mortality in immunocompromised patients, due to delayed diagnosis and treatment. Establishing a rapid, accurate diagnosis and a precise therapeutic regimen is crucial for management of the patients. Our report described a rare intracranial infection of patient with nephrotic syndrome.Patient ConcernsA 66-year-old woman with a history of nephrotic syndrome presented symptoms in central nervous system for 1 month, followed by headache and fever over several days.DiagnosisNeurological examination, brain imaging, and cerebrospinal fluid (CSF) tests exhibited resemblance to intracranial infection. Subsequently, CSF cultures confirmed the presence of Cryptococcus. Fortunately, next-generation sequencing revealed the concomitant infection with Nocardia farcinica in addition to Cryptococcus neoformans.InterventionsThe treatment with intravenous fluconazole combined with amphotericin could not immediately ameliorate her symptoms. The patient's condition improved significantly with minimal deficits after timely administration of antibiotics against N farcinica.OutcomesOne month later, cranial MRI indicated that basal ganglia lesions ameliorated. The patient has recovered well.Lessons SubsectionsTo our best knowledge, this is the first case report of intracranial infection caused by both N farcinica and C neoformans in a patient with nephrotic syndrome. Remarkably, extensive application of next-generation sequencing can facilitate investigation on the potential role of various pathogenic organisms in infectious diseases.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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