Pulmonary Nocardiosis with Brain Abscess in a Sensitized Kidney Transplant Recipient with a History of Repeated Graft Loss and HLA-Antibody Depletion Treatment – A case report

Biglarnia, Ali-Reza; Wadström, Jonas; Tufveson, Gunnar; Eriksson, Britt‐Marie

doi:10.3109/2000-1967-212

Cited by 7 publications

(11 citation statements)

References 11 publications

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“…The incidence of disseminated disease is 25-40%. [6] The risk of pulmonary and disseminated disease is greater among persons with deficient cellmediated immunity especially that associated with lymphoma, transplantation, [7] glucocorticoid therapy or AIDS.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Nocardiosis Mimicking Tuberculosis

Mahajan

Kashyap

2015

International Journal of Medical and Dental Sciences

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Pulmonary nocardiosis is an infrequent and severe infection due to Nocardia species, microorganisms that may behave both as opportunists and as primary pathogens. Diagnosis of pulmonary nocardiosis is frequently delayed and a high level of suspicion is required in patients with underlying diseases or chronic corticosteroid therapy. Hereby we are presenting a case of pulmonary nocardiosis mimicking tuberculosis in an immonocompromised patient.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Nocardiosis Mimicking Tuberculosis

Mahajan

Kashyap

2015

International Journal of Medical and Dental Sciences

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“…El paciente publicado por Verma (2008) desarrolló una persistente cefalea, cuya RM mostró imágenes de absceso en el lóbulo occipital, asociadas a una hemianopsia inadvertida para el paciente, alteraciones surgidas después de 24 años de una herida cortante en el cuero cabelludo 17 . Biglarnia (2008) describió un paciente que expresaba un cuadro pulmonar con tos y fiebre, cuyo examen neurológico era normal aunque la RM de cerebro mostraba abscesos en el lóbulo temporal derecho 18 . Del Pozo (2008) describió una paciente hospitalizada por fractura en hueso patológico, que mostraba en la RM de cerebro imágenes de abscesos frontales izquierdos sin clínica neurológica 19 .…”

Section: Discussionunclassified

Nocardiosis cerebral parvosintomática, en pacientes inmunocomprometidos

et al. 2013

Rev. chil. neuro-psiquiatr.

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Background: Nocardiosis is caused by several strains of Nocardia, Gram-positive bacteria that infects humans and animals likewise. They develop a systemic infection of pulmonary or cutaneous origin that can spread to the Central Nervous System. It frequently affects immunosupresed patients, in which parvosymptomatic cerebral abscess has been described, visible in magnetic resonance imaging but without focal symptoms. Patients and Methods: We want to communicate two women with renal transplant in immunosupresor treatment who were admitted to our hospital for acute pulmonar disease, during which patient A presented a convulsive episode and patient B headache and stupor, after which CT and MRI were obtained. In both cases multiple cerebral abscesses were found, of different sizes and location, with no clinical manifestations. Nocardia diagnosis was made in patient A by biopsy from a cutaneous mycetoma and in patient B after surgery of a cerebellar abscess. In both cases antimicrobial treatment was initiated with good response, but had to be interrupted due to adverse effects. This reactivated the infection, which had a complicated course and finally lead to the death of both patients. Conclusions: The fact that several cases of parvosymtomatic cerebral Nocardiosis in immunosupresed patients have been published suggest that cellular immunosupresion is key in the development of cerebral infections by Nocardia. It probably allows the access and multiplication of the bacteria inside the encephalon without an immediate clinical response. The development of symptoms is probably related to a late alteration of the blood-brain barrier rather than to the slow progression of Nocardia disease.

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“…Klinik ve otopsi çalışmalarında sistemik nokardiyozlu hastaların %15-44'ünde serebral apse bildirilmiştir (3,9,13). Akciğer nokardiyozlu olguların %25'inde serebral nokardiyoz gözlenmiştir.…”

Section: İrdelemeunclassified

“…Son yıllarda immünosüpresif ilaçların kullanımındaki artışla birlikte nokardiyoz olgularında artış olmuştur (7)(8)(9)(10)(11)(12).…”

Section: Introductionunclassified

Nocardia Brain Abscess in a Patient with Chronic Lymphocytic Leukemia

Vanli¹,

Sili²,

Saltoğlu³

et al. 2010

Klimik Dergisi

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ÖzetNocardia infeksiyonundan dolayı beyin apseleri immünosüp-rese hastada akut tıbbi yaklaşım gerektiren acil bir durumdur. Bakterinin tanımlanmasında gecikme yüksek mortalite oranın-dan sorumludur. İntrakraniyal tümörler ile karışabilir ve nüksü önlemek için drenaj sonrası uzun süreli antibiyotik kullanımı gerektirir. Bu yazıda kronik lenfositer lösemi nedeni ile izlenen, uzun süreli kortikosteroid tedavi alan bir hastada olası pulmoner nokardiyoza sekonder gelişen, cerrahi ve uzun süreli antimikrobiyal tedavi ile iyileşen serebral Nocardia apsesi sunulmuştur. Klimik Dergisi 2010; 23(3): 134-7. Anahtar Sözcükler: Nocardia, beyin apsesi, bağışıklığı baskılan-mış konak, ilaç tedavisi. AbstractBrain abscess due to Nocardia infection is an acute medical emergency among immunocompromised patients. Delayed identification of the bacteria is responsible for the high mortality rate. It may be confused with intracranial tumors and requires longterm antibiotic therapy after drainage. We report a case of Nocardia cerebral abscess in an immunocompromised patient. He was given steroids for chronic lymphocytic leukemia and developed suspected pulmonary nocardiosis. Then he developed a cerebral abscess due to Nocardia and was treated with surgery and longterm antimicrobial treatment. Klimik Dergisi 2010; 23(3): 134-7.Key Words: Nocardia, brain abscess, immunocompromised host, drug therapy. GirişNocardia'lar fırsatçı mikroorganizmalar olup, sıklık-la hücresel immünite ile ilgili defekti olanlarda infeksiyon nedenidir (1). Uzun süreli kortikosteroid kullanımı, kanserler, lokalize pulmoner hastalık belirlenmiş risk faktörleridir (2). Diğer ilişkili durumlar transplantasyon sonrası, diabetes mellitus, alkol veya İV ilaç bağımlılığı, HIV, kronik granülomatöz hastalık olarak bildirilmiştir (3). Nocardia'ların serebral yayılımı da görülmüştür. Nocardia beyin apseleri serebral apseler arasında yaklaşık %2 oranıyla nadir görülen ancak tüm serebral bakteriyel apselerden üç kat daha fatal seyirli infeksiyonlardır. Mortalite oranları %75-90 oranlarında bildirilmiştir (3-6).Son yıllarda immünosüpresif ilaçların kullanımındaki artışla birlikte nokardiyoz olgularında artış olmuştur (7-12).Tanının geç konulması ve tedavinin gecikmesi mortaliteyi artıracağından intrakraniyal apse saptanan immünosüpre-sif olgularda ayırıcı tanıda Nocardia apsesi düşünülmelidir. Bu yazıda kronik lenfositer lösemi tanısı ile izlenen hastada ortaya çıkan bir Nocardia beyin apsesi olgusu sunulmuştur.Olgu 60 yaşında erkek hasta 15 gün önce başlayan baş ağ-rısına son 10 gündür eklenen ateş, bulantı, kusma baş dönmesi, dengesizlik, yakınmalarıyla başvurdu. 2005 yılında kronik lenfositer lösemi tanısı aldığı ve tedavi ile kür sağlandığı öğrenildi. Eritroid seride aplazi nedeniyle, 6 aydan fazla süredir 20 mg/gün prednizolon kullanmakta olan hastaya, 2 ay önce pnömoni tanısıyla bir başka merkezde antibiyotik tedavisi uygulanmıştı.

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Pulmonary Nocardiosis with Brain Abscess in a Sensitized Kidney Transplant Recipient with a History of Repeated Graft Loss and HLA-Antibody Depletion Treatment – A case report

Cited by 7 publications

References 11 publications

Pulmonary Nocardiosis Mimicking Tuberculosis

Pulmonary Nocardiosis Mimicking Tuberculosis

Nocardiosis cerebral parvosintomática, en pacientes inmunocomprometidos

Nocardia Brain Abscess in a Patient with Chronic Lymphocytic Leukemia

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