ro13-9904 and Lupus-Erythematosus--Systemic

Topics: Adult; Anti-Bacterial Agents; Arthritis; Autoantibodies; Ceftriaxone; Diagnosis, Differential; Female; Gonorrhea; Hereditary Complement Deficiency Diseases; Humans; Immunologic Tests; Lupus Erythematosus, Systemic; Lupus Nephritis; Neisseria gonorrhoeae; Tenosynovitis; Treatment Outcome

We report the case of a 17-year-old adolescent girl with systemic lupus erythematosus with disseminated pneumococcal infection leading to purulent pericarditis with cardiac tamponade. Although pericarditis is not an uncommon entity in autoimmune diseases such as systemic lupus erythematosus, purulent pericarditis is a rare cause (<1%) of this presentation.

Topics: Acute Pain; Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Cardiac Tamponade; Ceftriaxone; Chest Pain; Echocardiography; Electrocardiography; Female; Humans; Lupus Erythematosus, Systemic; Pericardiocentesis; Pericarditis; Pneumococcal Infections; Streptococcus pneumoniae; Tomography, X-Ray Computed; Treatment Outcome

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Ciprofloxacin; Female; Humans; Immunocompromised Host; Lupus Erythematosus, Systemic; Meningitis, Bacterial; Middle Aged; Salmonella Infections

We describe a 19 year old woman with systemic lupus erythematosus on corticosteroid therapy, who developed bilateral, multiple, gas-forming Salmonella enteritidis leg abscesses and osteomyelitis mimicking deep vein thrombosis. The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone, followed by prolonged oral pefloxacin. This rare case of gas-producing S. enteritidis emphasizes the difficulty in diagnosing such complications in active systemic lupus erythematosus.

Topics: Abscess; Adult; Ceftriaxone; Drainage; Female; Humans; Leg; Lupus Erythematosus, Systemic; Osteomyelitis; Pefloxacin; Salmonella enteritidis; Salmonella Infections