mycophenolic-acid and Brain-Abscess

Opportunistic infections are an ongoing concern in patients with autoimmune disease who are being treated with immunosuppressive agents. Nocardiosis is an uncommon opportunistic infection which has been reported in association with immunosuppressed patients and autoimmune disease. It is challenging to diagnose and can have multisystem manifestations. Failure to diagnose and appropriately treat can result in significant mortality. We present a 49 year old woman with systemic lupus erythematosus and neuromyelitis optica spectrum disorder who was treated with mycophenolate mofetil, prednisone and recent plasmapheresis. She developed acute onset of shortness of breath and fevers and was ultimately diagnosed with disseminated nocardiosis with lung, brain and muscle abscesses.

Topics: Brain Abscess; Female; Humans; Imipenem; Immunocompromised Host; Lung Abscess; Lupus Erythematosus, Systemic; Middle Aged; Mycophenolic Acid; Neuromyelitis Optica; Nocardia Infections; Plasmapheresis; Prednisone; Radiography, Thoracic; Sulfamethoxazole; Tomography, X-Ray Computed; Trimethoprim

Topics: Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Nocardia; Nocardia Infections; Prednisone

Topics: Adolescent; Brain Abscess; Female; Humans; Immunosuppressive Agents; Listeria monocytogenes; Listeriosis; Lupus Erythematosus, Systemic; Mycophenolic Acid

Infection with Nocardia spp. is an uncommon but important cause of morbidity and mortality in organ transplant recipients. Cotrimoxazole prophylaxis against urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection occurred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, more potent and more diabetogenic immunosuppressive regimens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Diabetes Mellitus; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mycophenolic Acid; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination