Disseminated systemic Nocardia farcinica infection complicating alefacept and infliximab therapy in a patient with severe psoriasis

Summary Nocardiosis is a cause of significant morbidity and mortality in the immunocompromised host, and is an infrequent complication of tumor necrosis factor alpha (TNF-α) blockers in chronic inflammatory diseases. Nocardiosis occurs at a rate of 3.55 and 0.88 per 100 000 patients treated with inf...

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Bibliographic Details
Published in:International journal of infectious diseases 2010-02, Vol.14 (2), p.e153-e157
Main Authors: Al-Tawfiq, Jaffar A, Al-Khatti, Adil A
Format: Article
Language:English
Subjects:
Aged
Alefacept
Anti-TNF
Antibodies, Monoclonal - adverse effects
Antibodies, Monoclonal - therapeutic use
Brain abscess
Dermatologic Agents - adverse effects
Dermatologic Agents - therapeutic use
Fatal Outcome
Female
Humans
Immunocompromised Host
Infectious Disease
Infliximab
Nocardia - classification
Nocardia - genetics
Nocardia - isolation & purification
Nocardia farcinica
Nocardia Infections - diagnosis
Nocardia Infections - microbiology
Nocardia Infections - pathology
Psoriasis
Psoriasis - complications
Psoriasis - drug therapy
Psoriasis - physiopathology
Pulmonary/Respiratory
Recombinant Fusion Proteins - adverse effects
Recombinant Fusion Proteins - therapeutic use
Severity of Illness Index
Tumor Necrosis Factor-alpha - antagonists & inhibitors
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Summary:Summary Nocardiosis is a cause of significant morbidity and mortality in the immunocompromised host, and is an infrequent complication of tumor necrosis factor alpha (TNF-α) blockers in chronic inflammatory diseases. Nocardiosis occurs at a rate of 3.55 and 0.88 per 100 000 patients treated with infliximab or etanercept, respectively. Disseminated nocardiosis remains an uncommon complication of these agents. Here, we present a fatal case of disseminated systemic nocardiosis in a patient with psoriasis following sequential therapy with alefacept and then infliximab therapy. The patient developed disseminated disease involving the brain, lymph nodes, and adrenal glands. The diagnosis was made by blood culture and aspiration of the adrenal gland abscess, which revealed Gram-positive bacilli and later grew Nocardia farcinica . The organism was identified by DNA sequencing, and was susceptible to moxifloxacin, gatifloxacin, ciprofloxacin, amoxicillin–clavulanic acid, linezolid, sulfamethoxazole, and amikacin. It was resistant to clarithromycin, ceftriaxone, and tobramycin and was intermediately susceptible to imipenem.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2009.03.017