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

More than meets the eye: Nocardia farcinica, Candida dubliniensis and Aspergillus spp. co-infection in a patient with multiple myeloma treated with multiple treatment regimens

BACKGROUND

Invasive infections by Nocardia farcinica, Aspergillus species (spp.) and Candida dubliniensis are rare infectious complications in patients diagnosed with multiple myeloma.

CASE PRESENTATION

In this case report, we describe a patient who received three lines of therapy, with proteasome inhibitors, corticosteroids, cyclophosphamide and lenalidomide, and who was concurrently infected with these three opportunistic pathogens. A blood stream infection with C. dubliniensis was treated with 4 weeks of anidulafungin. Aspergillus spp. was treated for 12 weeks with voriconazole. N. farcinica treatment was continued indefinitely with co-trimoxazole and moxifloxacin after regression at discharge of brain abscesses and the pulmonary aspergilloma.

CONCLUSION

The diagnostic challenges and management in this particularly vulnerable patient are highlighted.

Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China

Background

Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms.

Methods

A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected.

Results

Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P = 0.016).

Conclusions

Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.