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

Nengwen Xu,Wen Lei,Linjie Li,Wenbin Qian

doi:10.3390/brainsci11091204

Nengwen Xu, Wen Lei + Show 2 more

Open Access

https://doi.org/10.3390/brainsci11091204

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Abstract

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.

Highlights

Report and Review of the Literature.Nocardiosis is a localized or disseminated infection caused by an aerobic actinomycete that is soil-borne with a worldwide distribution [1]
There are very few case reports of Nocardia farcinica brain abscesses associated with proteasome inhibitors and no cases have been reported from China
We report a case of Nocardia farcinica brain abscess in a multiple myeloma patient treated with proteasome inhibitor, cyclophosphamide, and corticosteroid

Summary

Introduction

Every year about 500 to 1000 new cases of Nocardia infections are reported [2,3] and most patients were in immunodeficiency states (such as diabetes and acquired immunodeficiency syndrome [AIDS]). In the past fifteen years, proteasome inhibitor treatment has had a favorable effect on the long-term survival rate of patients with multiple myeloma [5]. These drugs inhibit the ubiquitin-proteasome pathway affecting cellular and humoral immunity [6]. We report a case of Nocardia farcinica brain abscess in a multiple myeloma patient treated with proteasome inhibitor, cyclophosphamide, and corticosteroid. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations

Case Presentation

Partial

Discussion

Findings

23 July 2020

Conclusions