Brain abscesses caused by Nocardia paucivorans in a multiple myeloma patient treated with lenalidomide and dexamethasone: a case report and review of literature.
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Keywords
Nocardia paucivorans, Brain Abscess, Multiple Myeloma, Lenalidomide
Abstract
We report the first case of multiple brain abscesses caused by Nocardia paucivorans in a patient suffering from multiple myeloma on treatment with lenalidomide and dexamethasone. Nocardia paucivorans is a recently described species of the genus Nocardia, which is supposed to have a heightened neurotropism in cases of disseminated infection. Although nocardiosis itself is an uncommon infectious complication in multiple myeloma so far, nocardial brain abscess should be added to the spectrum of adverse effects due to this novel chemotherapy regimen.
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References
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2. Mishra SK, Gordon R, Barnett DA Identification of nocardiae and actinomycetes of medical importance. J Clin Microbiol 1980; 11: 728-736
3. Clinical and Laboratory Standards Institute (CLSI). Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes. CLSI document M24-A2, March 2011, Wayne, Pennsylvania 19087-1898 USA, 2011.
4. Yassin AF, Rainey FA, Burghardt J, Brzezinka H, Mauch M, Schaal KP. Nocardia paucivorans sp. nov. Int J Syst Evol Microbiol. 2000; 50 Pt 2: 803-9.
5. Wauters G, Avesani V, Charlier J, Janssens M, Veneechoutte M, Delmée M. Distribution of Nocardia species in clinical samples and their routine rapid identification in the laboratory. J Clin Microbiol. 2005; 43: 2624-2628.
6. McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev. 1994; 7: 357–417.
7. Wilson JW. Nocardiosis: Updates and Clinical Overview. Mayo Clin Proc. 2012; 87: 403–407. doi: 10.1016/j.mayocp.2011.11.016.
8. Corti ME, Villafañe-Fioti MF. Nocardiosis: a review. Int J Infect Dis. 2003; 7: 243-50.
9. Anagnostou T, Arvanitis M, Kourkoumpetis TK, Desalermos A, Carneiro HA, Mylonakis E. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore). 2014; 93:19-32.
10. Gray TJ, Serisier DJ, Gilpin CM, Coulter C, Bowler SJ, McCormack JG. Nocardia paucivorans --a cause of disseminated nocardiosis. J Infect. 2007; 54: e95-8.
11. Hammoud M, Kraft C, Pulst-Korenberg J, Chenoweth C, Gregg KS. Disseminated Nocardia paucivorans infection in an immunocompetent host. Infection. 2014 15. [Epub ahead of print]
12. Chouciño C, Goodman SA, Greer JP, Stein RS, Wolff SN, Dummer JS. Nocardial infections in bone marrow transplant recipients. Clin Infect Dis. 1996; 23: 1012-9.
13. Pamukçuo?lu M, Emmez H, Tunçcan OG, Oner AY, C?rak MY, Senol E, Sucak GT. Brain abscess caused by Nocardia cyriacigeorgica in two patients with multiple myeloma: novel agents, new spectrum of infections. Hematology. 2014; 19: 158-62.
14. Eisenblätter M, Disko U, Stoltenburg-Didinger G, Scherübl H, Schaal KP, Roth A, Ignatius R, Zeitz M, Hahn H, Wagner J. Isolation of Nocardia paucivorans from the cerebrospinal fluid of a patient with relapse of cerebral nocardiosis. J Clin Microbiol. 2002; 40: 3532-4.
15. Khan SH, Sanche SE, Robinson CA, Pirouzmand FN. paucivorans infection presenting as a brain abscess. Can J Neurol Sci. 2006; 33: 426-7.
16. König C, Kleber M, Reinhardt H, Knop S, Wäsch R, Engelhardt M. Incidence, risk factors, and implemented prophylaxis of varicella zoster virus infection, including complicated varicella zoster virus and herpes simplex virus infections, in lenalidomide-treated multiple myeloma patients. Ann Hematol. 2014; 93: 479-84.
17. Borrello I. Can we change the disease biology of multiple myeloma?Leuk Res. 2012; 36: S3–12.
18. Teo SK. Properties of thalidomide and its analogues: implications for anticancer therapy. AAPS J. 2005 22;7: E14-9.
19. Yang B, Yu RL, Chi XH, Lu XC. Lenalidomide treatment for multiple myeloma: systematic review and meta-analysis of randomized controlled trials. PLoS One. 2013 14;8: e64354.
20. Jung SH, Bae SY, Ahn JS, Kang SJ, Yang DH, Kim YK, Kim HJ, Lee JJ. Lymphocytopenia is associated with an increased risk of severe infections in patients with multiple myeloma treated with bortezomib-based regimens. Int J Hematol. 2013 ;97: 382-7.
21. Nucci M, Anaissie E. Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents. Clin Infect Dis. 2009 15;49:1211-25.
22. Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S, Santos Durantez M, Vallés Tarazona JM, Modesto Alapont M, Gobernado Serrano M. Pulmonary nocardiosis: risk factors and outcomes. Respirology. 2007;12: 394-400.