Antineoplastics
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Reactions 1270 - 19 Sep 2009 S Antineoplastics Nocardia exalbida brain abscess: case report A 63-year-old man developed a Nocardia exalbida brain abscess during treatment with antineoplastics [dosages not stated], including cladribine, for follicular lymphoma. The man was diagnosed with follicular lymphoma in September 2000; he subsequently received cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP regimen), followed by cyclophosphamide, prednisolone and vincristine (COP regimen), and remission was achieved. In January 2001, he was referred for follow-up and, relapsed three times thereafter. Remission was achieved each time with cyclophosphamide, vincristine, procarbazine, prednisolone (C-MOPP regimen), and/or rituximab. He started receiving cladribine 0.09 mg/kg as a continuous infusion (days 1-7), for a fifth relapse in 2005, of which he received three cycles. He also received cotrimoxazole [trimethoprim/sulfamethoxazole] for Pneumocystis jiroveci prophylaxis. Due to tumour regrowth in December 2005, he received six cycles of the C-MOPP regimen. He was hospitalised during his sixth course in August 2006, due to febrile neutropenia. A chest X-ray and CT scan showed a nodule in his left lung. He received imipenem, with a slight reduction in his lung nodule. His performance status improved, he became afebrile, and he was discharged. A further three cycles of C-MOPP were administered, and he developed high-grade fever, nausea, vomiting and headache during his last cycle in November 2006; he was hospitalised. Palpable superficial lymph nodes, slight drowsiness, and a left visual-field defect were evident on physical examination. A brain CT scan demonstrated a ring- enhancing, multiloculated lesion with marginal oedema in the right occipital lobe. He had developed complete hemianopia. His haemoglobin level was 9.3 g/dL, his WBC count was 5300 /µL, his platelet count was 15 × 10 4 /µL, his serum sodium and chloride levels were 123 and 89 mEq/L, respectively, and his CRP level was 2.0 mg/dL. A chest CT scan showed that his left-lung nodule remained. Needle aspiration of the brain lesion was performed, and N. exalbida was identified. The man started receiving cotrimoxazole and meropenem. One month later, his neurological symptoms had improved and, a follow-up CT scan showed brain- abscess resolution and lung-nodule shrinkage. Totally 2 months later [sic], his brain abscess had decreased in size and his lung nodule was absent. After 4 months of therapy, he was discharged with no neurological deficit, in a stable condition. After 6 months of therapy, he had no recurrence of the brain abscess. Ono M, et al. Nocardia exalbida brain abscess in a patient with follicular lymphoma. International Journal of Hematology 88: 95-100, No. 1, Jul 2008 - Japan 801150496 1 Reactions 19 Sep 2009 No. 1270 0114-9954/10/1270-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1270 - 19 Sep 2009
SAntineoplastics
Nocardia exalbida brain abscess: case reportA 63-year-old man developed a Nocardia exalbida brain
abscess during treatment with antineoplastics [dosages notstated], including cladribine, for follicular lymphoma.
The man was diagnosed with follicular lymphoma inSeptember 2000; he subsequently receivedcyclophosphamide, vincristine, doxorubicin andprednisolone (CHOP regimen), followed bycyclophosphamide, prednisolone and vincristine (COPregimen), and remission was achieved. In January 2001, hewas referred for follow-up and, relapsed three timesthereafter. Remission was achieved each time withcyclophosphamide, vincristine, procarbazine,prednisolone (C-MOPP regimen), and/or rituximab. Hestarted receiving cladribine 0.09 mg/kg as a continuousinfusion (days 1-7), for a fifth relapse in 2005, of which hereceived three cycles. He also received cotrimoxazole[trimethoprim/sulfamethoxazole] for Pneumocystis jiroveciprophylaxis. Due to tumour regrowth in December 2005,he received six cycles of the C-MOPP regimen. He washospitalised during his sixth course in August 2006, due tofebrile neutropenia. A chest X-ray and CT scan showed anodule in his left lung. He received imipenem, with a slightreduction in his lung nodule. His performance statusimproved, he became afebrile, and he was discharged. Afurther three cycles of C-MOPP were administered, and hedeveloped high-grade fever, nausea, vomiting andheadache during his last cycle in November 2006; he washospitalised. Palpable superficial lymph nodes, slightdrowsiness, and a left visual-field defect were evident onphysical examination. A brain CT scan demonstrated a ring-enhancing, multiloculated lesion with marginal oedema inthe right occipital lobe. He had developed completehemianopia. His haemoglobin level was 9.3 g/dL, his WBCcount was 5300 /µL, his platelet count was 15 × 104/µL, hisserum sodium and chloride levels were 123 and 89 mEq/L,respectively, and his CRP level was 2.0 mg/dL. A chest CTscan showed that his left-lung nodule remained. Needleaspiration of the brain lesion was performed, andN. exalbida was identified.
The man started receiving cotrimoxazole andmeropenem. One month later, his neurological symptomshad improved and, a follow-up CT scan showed brain-abscess resolution and lung-nodule shrinkage. Totally2 months later [sic], his brain abscess had decreased in sizeand his lung nodule was absent. After 4 months of therapy,he was discharged with no neurological deficit, in a stablecondition. After 6 months of therapy, he had no recurrenceof the brain abscess.Ono M, et al. Nocardia exalbida brain abscess in a patient with follicularlymphoma. International Journal of Hematology 88: 95-100, No. 1, Jul 2008 -Japan 801150496
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Reactions 19 Sep 2009 No. 12700114-9954/10/1270-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
