Clinical Rheumatology

, Volume 26, Issue 6, pp 1020–1022

Nocardia brain abscesses in a male patient with SLE: successful outcome despite delay in diagnosis

  • Maria Justiniano
  • Sarah Glorioso
  • Sylvia Dold
  • Luis R. Espinoza
Case Report

DOI: 10.1007/s10067-006-0262-x

Cite this article as:
Justiniano, M., Glorioso, S., Dold, S. et al. Clin Rheumatol (2007) 26: 1020. doi:10.1007/s10067-006-0262-x
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Abstract

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.

Keywords

Brain abscess Immunosuppression Lupus Nocardiosis 

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  • Maria Justiniano
    • 1
  • Sarah Glorioso
    • 1
  • Sylvia Dold
    • 1
  • Luis R. Espinoza
    • 1
    • 2
  1. 1.Department of Medicine, Section of RheumatologyLSU Health Sciences Center at New OrleansNew OrleansUSA
  2. 2.Section of RheumatologyLSU Health Sciences Center at New OrleansNew OrleansUSA

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