cefotaxime and Lupus-Erythematosus--Systemic

We report a 54 year old female whose successful treatment of cerebral lupus with rituximab was complicated by the development of streptococcus intermedius, on valves damaged by Libman-Sacks endocarditis more than 20 years previously.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents; Cefotaxime; Endocarditis, Bacterial; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Penicillin G; Rituximab; Streptococcal Infections; Streptococcus intermedius

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

A 17-year-old female with a 5-year history of disseminated lupus erythematosus has remained without immunosuppressive therapy for the last 3 years. She was admitted to the hospital for acute abdominal pain, generalized edema, and rapidly developing dyspnea and somnolence. Although all symptoms were consistent with active SLE, septicemia was suspected because of leukocytosis (20,000/microliters), greatly elevated C-reactive protein (45 mg/dl), and normal complement values (C3 0.74 g/l, C4 0.21 g/l). Directly after bacterial blood cultures were prepared, a combined treatment was instituted consisting of plasmapheresis (3 x 2.1 l against fresh frozen plasma), antibiotics, prednisolone, and cyclophosphamide following the last plasmapheresis. Within three days cerebral function returned to normal, edema improved, and CRP fell to 0.5 mg/dl. The blood cultures and pericardial effusion displayed meningococcal colonies.

Topics: Adolescent; Cefotaxime; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Meningococcal Infections; Pericardial Effusion; Plasmapheresis; Sepsis