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Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide

Nature Clinical Practice Oncology volume 3, pages 339–343 (2006)Cite this article

Abstract

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.

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

Diagnosis 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.

Management Discontinuation of temozolomide, discontinuation of radiotherapy, antibiotic treatment with amoxicillin and gentamicin, and administration of atovaquone and pentamidine.

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Figure 1: Contrast-enhanced MRI of the patient's brain showing a lesion, compatible with an abscess, located in the left lenticular nucleus and in the head of the caudate nucleus.
Figure 2: Photograph of the patient's hand, showing Kaposi's sarcoma nodules.
Figure 3: Histology of the patient's skin biopsy sample.

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Acknowledgements

We thank A Telenti and M Fontana for advice and critical review of the manuscript. Written consent for publication was obtained from the patient.

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Authors and Affiliations

  1. internal medicine,

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  2. radiation oncologist,

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  3. neurosurgeon in training,

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  4. Head of the Clinical Research Unit at the Multidisciplinary Oncology Center, all at the University of Lausanne Hospitals, Lausanne

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  5. Chief Resident at the Riviera Hospital, Vevey

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  6. consultant in infectious diseases in Sion,

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

  7. University Institute of Pathology, Lausanne, Switzerland

    Vincent Ganière, Grégoire Christen, Frank Bally, Louis Guillou, Alessia Pica, Sandrine de Ribaupierre & Roger Stupp

Authors
  1. Vincent Ganière
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  2. Grégoire Christen
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  7. Roger Stupp
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Corresponding author

Correspondence to Roger Stupp.

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Competing interests

Dr Stupp has served as a consultant and speaker for Schering-Plough. He has received honoraria and research support.

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Ganière, V., Christen, G., Bally, F. et al. Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide. Nat Rev Clin Oncol 3, 339–343 (2006). https://doi.org/10.1038/ncponc0514

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