Document Detail


Nocardia brain abscesses in a male patient with SLE: successful outcome despite delay in diagnosis.
MedLine Citation:
PMID:  16683177     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report a 37-year-old African-American man with systemic lupus erythematosus (SLE) diagnosed in May 2001 when he presented with biopsy-proven nephritis. He had been treated intermittently from May 2001 to November 2004 with intravenously (i.v.) administered cyclophosphamide and high doses of prednisone due to unrelenting proteinuria. In November 2004, he was admitted to the hospital because of deterioration of renal function and massive proteinuria (21 g dl(-1) 24 h(-1)) and treated with pulses of methylprednisolone and two courses of i.v. administered cyclophosphamide. His hospital course was complicated by cellulitis and bacteremia with Pseudomonas spp. and Streptococcus bovis. He was discharged on prednisone 60 mg daily, ciprofloxacin, augmentin, and hemodialysis. He was readmitted a week later with new onset of seizure activity, slurred speech, and left-sided hemiparesis. Magnetic resonance imaging of the brain revealed multiple ringlike enhancing foci in the frontal and occipital lobes. Brain biopsy was performed, and Gram stain and initial cultures were negative. Empiric tobramycin, cefepime, and metronidazole were administered. Diagnosis was delayed for several months, but culture eventually grew Nocardia asteroides. Trimethoprim-sulfomethoxazole and linezolid therapy was begun. This was followed by slow, but steady, clinical improvement. Risk factors, diagnostic clues, and treatment are reviewed.
Authors:
Maria Justiniano; Sarah Glorioso; Sylvia Dold; Luis R Espinoza
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2006-05-09
Journal Detail:
Title:  Clinical rheumatology     Volume:  26     ISSN:  0770-3198     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-04-30     Completed Date:  2007-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  1020-2     Citation Subset:  IM    
Affiliation:
Department of Medicine, Section of Rheumatology, LSU Health Sciences Center at New Orleans, New Orleans, LA 70112-2282, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain Abscess / diagnosis,  drug therapy*,  etiology
Humans
Immunosuppressive Agents / adverse effects*
Lupus Erythematosus, Systemic / microbiology*
Male
Nocardia Infections / diagnosis,  drug therapy*,  etiology
Nocardia asteroides / pathogenicity*
Seizures / etiology
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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