Intracranial Nocardia recurrence during fluorinated quinolones therapy.
Nocardia infection is a well-recognized complication in renal transplant recipients and other immunocompromised hosts. It is mostly a primary pulmonary infection, which can disseminate to other organs in half of the cases. Nocardiosis is a life-threatening infection. Therefore, an efficient long-lasting treatment must be rapidly administered. We report 1 case of disseminated nocardiosis with pulmonary involvement, brain lesions, and bone lesions in a renal transplant patient, who was treated with stereotactic aspiration in association with high dose of trimethoprim/sulfamethoxazole (TMP/SMX) and imipenem, changed, after 3 weeks to moxifloxacin. First, clinical manifestations decreased after surgical drainage and combination therapy with the 2 antimicrobial agents, but later the patient developed a recurrence of brain lesions during treatment with quinolones. Consequently, the patient was again treated with TMP/SMX and imipenem, after which the patient recovered. It is surprising that moxifloxacin was efficient in vitro and the antimicrobial concentration in the central nervous system was high, yet the nocardial abscess recurred under this therapy.
Dahan
K
K
Service de Néphrologie, Hôpital Foch, Créteil, France. karineydahan@yahoo.fr
El Kabbaj
D
D
Venditto
M
M
Pastural
M
M
Delahousse
M
M
D000583:Amikacin / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology; D004338:Drug Combinations; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D009615:Nocardia / Q000187:drug effects / Q000254:growth & development*; D009617:Nocardia Infections / Q000188:drug therapy* / Q000382:microbiology; D011804:Quinolines / Q000627:therapeutic use; D013419:Sulfamethizole / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D000096926:Benzenesulfonamides
D000583:Amikacin; D001372:Aza Compounds; D004338:Drug Combinations; D024841:Fluoroquinolones; D015378:Imipenem; D000077266:Moxifloxacin; D011804:Quinolines; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides