Ciclosporin/methylprednisolone

Abstract

Multisystem Nocardia infection: case report A 42-year-old woman developed multisystem Nocardia infection during treatment with ciclosporin and methylprednisolone [routes, dosages, duration of treatments to reaction onset not stated; not all indications stated]. The woman, who had a history of chronic kidney disease, membranous nephropathy and type 2 diabetes, presented with cough and expectoration. She was diagnosed with pulmonary infection. Previously, she was treated with voriconazole and multiple antibiotics in other hospitals after stopping immunosuppressive ciclosporin therapy. She had been receiving methylprednisolone [Medrol]. On current presentation, cystic masses were found on the popliteal fossa, buttocks and right temporal, accompanied by pain. A head MRI revealed multiple brain abscesses, and a chest CT scan showed right lung infection. A soft tissue puncture fluid and routine culture of the blood were positive for Nocardia species. The woman’s methylprednisolone dose was reduced, and she was treated with imipenem, linezolid, cilastatin [Cilastatin sodium], minocycline and cotrimoxazole [sulfamethoxazole/trimethoprim]. However, she suddenly developed epilepsy and cardiopulmonary arrest, which was successfully treated. Her urine protein and renal function was normal during 6 months follow up visit. Imaging findings revealed controlled infection.