Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide.
BACKGROUND
A 55-year-old man with glioblastoma multiforme was treated with continuous, dose-dense temozolomide. This therapy was curtailed after three cycles because of nausea, asthenia, and neuropsychological deterioration. During a subsequent course of radiotherapy, the patient developed fever, headaches, and cutaneous lesions.


METHODS
Physical examination, cerebral MRI, brain biopsy, skin biopsy, immunohistochemistry, bronchoscopy with bronchoalveolar lavage, and laboratory tests.


METHODS
Severe temozolomide-induced immunosuppression, exacerbated by corticosteroids, with profound T-cell lymphocytopenia and simultaneous opportunistic infections with Pneumocystis jiroveci pneumonia, brain abscess with Listeria monocytogenes, and cutaneous Kaposi's sarcoma.


RESULTS
Discontinuation of temozolomide, discontinuation of radiotherapy, antibiotic treatment with amoxicillin and gentamicin, and administration of atovaquone and pentamidine.
Ganière
Vincent
V
University of Lausanne Hospitals, Lausanne, Switzerland.
Christen
Grégoire
G
Bally
Frank
F
Guillou
Louis
L
Pica
Alessia
A
de Ribaupierre
Sandrine
S
Stupp
Roger
R
D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001922:Brain Abscess / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005909:Glioblastoma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008088:Listeriosis / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000139:chemically induced* / Q000188:drug therapy; D012514:Sarcoma, Kaposi / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D000077204:Temozolomide
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide