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Intractable cerebral Nocardia mexicana in a GvHD patient successfully treated with linezolid

Bone Marrow Transplantation volume 52, pages 1476–1478 (2017)Cite this article

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Patients undergoing allogenic hematopoietic stem cell transplant (allo-HCT) have a higher risk of developing nocardiosis.1 Risk is high due to immunosuppressive nature of the procedure and medications to prevent and treat GvHD. Nocardia is a weakly acid-fast, Gram-positive filamentous bacterium most commonly found in soil and water. Infections from Nocardia spp. occur through inhalation or direct inoculation into the skin. Pulmonary involvement is the most common, but the organism can disseminate to any organ most commonly to the central nervous system (CNS). Nocardia is an opportunistic organism with most infections occurring in immunocompromised hosts, including those with AIDS, allo-HCT, solid organ transplant, malignancy, diabetes mellitus, TNF-α inhibitor treatment, chronic granulomatous disease, alcoholism, CMV infection, chronic obstructive pulmonary disease and patients on long-term immunosuppressive drugs.2, 3, 4

TMP/SMX is the mainstay of treatment for nocardiosis. However, there are serious issues of drug resistance5 and potential side effects like myelosuppression, hepatotoxicity, renal toxicity and significant hypersensitivity reactions with TMP/SMX.6 Combination with other antibiotics, including amikacin, carbapenems, cephalosporin and fluoroquinolones have been used in patients with disseminated disease.6 These alternative antibiotics have narrow therapeutic margins and are not active against all nocardia species.4 Vera-Cabrera et al.,7 for the first time, studied the activity of linezolid against Nocardia spp. in 2001. All clinically significant strains of nocardia were sensitive to linezolid.7 Moylett et al.,8 in 2003, reported six cases of nocardiosis successfully treated with linezolid.4 Since 2003, a handful of cases of cerebral nocardiosis treated with linezolid have been published in the literature. Most of them were due to Nocardia farcinica species.3, 8, 9, 10 Only one case of cerebral Nocardia mexicana with unsuccessful treatment has been reported.11 We describe the first case of intractable cerebral nocardiosis with Nocardia mexicana that was successfully treated with linezolid after failing multiple anti-nocardial regimens.

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Acknowledgements

This work was funded by U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI) Grant number - P30 CA023074 (to FA).

Author contributions

AM, TZ, RE, FA designed the study. All authors performed the study, contributed to the data extraction, literature review, analyzed the data, and wrote the paper.

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Authors and Affiliations

  1. Division of Infectious Disease, Department of Medicine, University of Arizona, Tucson, AZ, USA

    A Majeed, T Zangeneh & R E Ramahi

  2. Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona Cancer Center, Tucson, AZ, USA

    A Mushtaq, S Batool, H Khan, A Latif & V Kapoor

  3. Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA

    F Anwer

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  1. A Majeed
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Correspondence to F Anwer.

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Majeed, A., Mushtaq, A., Zangeneh, T. et al. Intractable cerebral Nocardia mexicana in a GvHD patient successfully treated with linezolid. Bone Marrow Transplant 52, 1476–1478 (2017). https://doi.org/10.1038/bmt.2017.167

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