title: Myelosuppression-sparing treatment of central nervous system nocardiosis in a multiple myeloma patient utilizing a tedizolid-based regimen: a case report.
abstract: Central nervous system (CNS) nocardiosis is a recognised opportunistic infection in immunocompromised patients. Treatment involves prolonged institution of antibiotics, making oral agents a convenient and desired option. Unfortunately, devising an effective, well-tolerated antimicrobial for the duration required to treat CNS nocardiosis is challenging owing to treatment intolerance and toxicities. This report highlights myelosuppression-sparing treatment with an oral tedizolid-based regimen following a complicated course with standard agents. A 68-year-old female from Florida (USA) with low-risk lambda light chain multiple myeloma complicated by persistently low CD4 counts, absolute neutrophil counts and IgG levels presented 18 months after diagnosis with fever, pneumonia, new-onset atrial fibrillation, right-sided hemiparesis, encephalopathy and slurred speech. Magnetic resonance imaging (MRI) showed numerous ring-enhancing lesions, and blood cultures were positive for Nocardia farcinica. The patient failed initial therapy with trimethoprim/sulfamethoxazole (SXT), linezolid and imipenem plus surgical debridement of the frontal lobe abscess. Intraoperative cultures were positive for N. farcinica. The treatment course was also complicated by steadily declining white blood cell and platelet counts despite receiving filgrastim. She was therefore placed on SXT and tedizolid for 6 months. Subsequent brain MRI showed complete resolution of the lesions and thus chemotherapy for multiple myeloma was re-initiated. In conclusion, tedizolid-based regimens may be an option for patients with myelosuppression requiring prolonged antibiotic therapy for CNS nocardiosis.
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Aasiya
authors.initials: A
authors.lastname: Matin
authors.affiliation: Department of Veterans Affairs, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Smriti
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Cincinnati, 231 Albert Sabin Way, MSB 6153B, Cincinnati, OH 45267, USA. Electronic address: apewoksu@ucmail.edu.
authors.forename: Senu K
authors.initials: SK
authors.lastname: Apewokin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000000981:diagnostic imaging; D002494:Central Nervous System Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003646:Debridement; D005260:Female; D005431:Florida; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology; D009615:Nocardia / Q000145:classification / Q000302:isolation & purification; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D010755:Organophosphates / Q000627:therapeutic use*; D010080:Oxazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D010755:Organophosphates; D010080:Oxazoles; C515040:tedizolid phosphate
keywords: Brain abscess; Myelosuppression; Norcardia; Tedizolid