Nocardia intracranial mycotic aneurysm associated with proteasome inhibitor

Chansirikarnjana, Siriththin; Apisarnthanarak, Anucha; Suwantarat, Nuntra; Damronglerd, Pansachee; Rutjanawech, Sasinuch; Visuttichaikit, Suttichai; Khawcharoenporn, Thana

doi:10.1016/j.idcr.2019.e00601

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…Therefore, all patients with pulmonary nocardia disease should accept brain imaging [17]. In previous reports [18][19][20], four patients with multiple myeloma who received bortezomib and dexamethasone developed central nervous system symptoms (Table 2). Proteasome inhibitors, such as bortezomib and carfilzomib, can reduce the effects of T cells, B cells, NK cells, and dendritic cells on the host immune system [21].…”

Section: Discussionmentioning

confidence: 99%

Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

Lei

et al. 2021

Brain Sciences

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Nocardia brain abscess is relatively rare, accounting for about 1–2% of all brain abscesses, and its mortality rate is three times higher than of other types of bacterial brain abscesses; thus, early diagnosis and treatment are essential. Nocardia brain abscess generally occurs in immunodeficient patients. We report a case of Nocardia farcinica brain abscess in a multiple myeloma patient treated with proteasome inhibitor (bortezomib and ixazomib), cyclophosphamide, and corticosteroid. The patient was treated with ceftriaxone and trimethoprim-sulfamethoxazole, together with drainage of the brain abscess. Regular brain MRI follow-ups showed that intracranial lesions were gradually absorbed and improved.

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Section: Discussionmentioning

confidence: 99%

Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

Lei

et al. 2021

Brain Sciences

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“…Concerning the outcome of reported cases of Nocardia intracranial infected aneurysms, a good clinical outcome was achieved in two cases where one case had an unruptured aneurysm[ 10 ] and another had a ruptured aneurysm of the M2-3 segment with good preoperative grade. [ 5 ] The remaining three cases include one with clinically improved and two patients who died. The causes of the poor outcome were poor preoperative grade,[ 11 ] intracranial bleeding due to intrathecal tissue plasminogen activator administration,[ 12 ] and uncontrolled infection, as in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the ruptured cerebral-infected aneurysm secondary to Nocardia infection is extremely rare, with only four cases described in the literature. [5,[10][11][12] An infected intracranial aneurysm caused by the bacteria usually involves the distal vasculature due to lodged emboli, in contrast to the fungi (mycotic aneurysm) that would commonly destroy proximal vessels wall and manifest as cerebral infarction due to its angioinvasive nature. e mortality rate could increase to 90% in the case of intracranial vessel destruction.…”

Section: Introductionmentioning

confidence: 99%

A rare case of ruptured anterior cerebral artery infected aneurysm with angioinvasion secondary to disseminated Nocardia otitidiscaviarum: A case report and literature review

Duangprasert¹,

Kebboonkird²,

Ratanavinitkul³

et al. 2022

Surgical Neurology International

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Background: The cases of ruptured infected aneurysms secondary to disseminated nocardiosis are exceptionally rare. Therefore, there is no guideline for investigation or optimal treatment. Case Description: A 51-year-old man with immunocompromised status was first presented with pneumonia and cerebral infarction, where the infected aneurysm was ruptured thereafter. Intraoperative findings revealed left anterior cerebral artery thrombosis and occlusion with evidence of angioinvasion along with pus discharge which was later identified with Nocardia otitidiscaviarum. Our case was the first to report on the angioinvasive nature of cerebral nocardiosis, which occurs concurrently with a ruptured infected aneurysm and an unusual presentation that made the diagnosis and treatment challenging. Conclusion: Cerebral nocardiosis may cause ruptured infected aneurysms in patients with risk factors, especially for immunocompromised hosts. Furthermore, Nocardia can present with severe cerebral manifestation due to angioinvasion causing cerebral infarction accompanied by a ruptured infected aneurysm.

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“… [15] The most common manifestation of CNS infection is brain abscess. There have been three reported cases of Nocardia causing aneurysms in intracerebral arteries [17] , [18] , [19] . One of these three patients had a background of SLE and was getting steroids while another one had multiple myeloma.…”

Section: Discussionmentioning

confidence: 99%

Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature

Parengal

Alebbi

Hamed

et al. 2021

IDCases

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Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum ( N . otitidiscaviarum ) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.

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Nocardia intracranial mycotic aneurysm associated with proteasome inhibitor

Cited by 11 publications

References 15 publications

Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

Nocardia farcinica Brain Abscess in a Multiple Myeloma Patient Treated with Proteasome Inhibitor: A Case Report and Review of the Literature

A rare case of ruptured anterior cerebral artery infected aneurysm with angioinvasion secondary to disseminated Nocardia otitidiscaviarum: A case report and literature review

Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature

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