ABSTRACT
We describe a case of pulmonary nocardiosis in a female patient with graft-versus-host disease (GVHD) underwent therapy with imatinib mesylate for a relapse of chronic myeloid leukemia (CML) after allogeneic bone marrow transplantation (BMT). The patient developed chronic GVHD 8 months after the use of imatinib and was on corticosteroid therapy. Three months after the development of chronic GVHD, she acquired pulmonary nocardiosis and a computed tomography (CT) scan of the chest showed multiple nodular lesions with cavitations over both lungs. She was successfully treated with single-agent trimethoprim-sulfamethoxazole (TMP/SMX) and the infection did not recur. Our case indicated that pulmonary nocardiosis could occur in patients with GVHD undergoing imatinib and corticosteroid therapy and might be treated by single-agent TMP/SMX.
Subject(s)
Bone Marrow Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Nocardia Infections/etiology , Nocardia asteroides/isolation & purification , Piperazines/therapeutic use , Pneumonia, Bacterial/etiology , Pyrimidines/therapeutic use , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Bacterial Agents/therapeutic use , Benzamides , Bronchiolitis Obliterans/etiology , Female , Graft vs Host Disease/complications , Humans , Imatinib Mesylate , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Lung/diagnostic imaging , Nocardia Infections/diagnostic imaging , Nocardia Infections/drug therapy , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Tomography, X-Ray Computed , Transplantation, Homologous , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
The mechanisms responsible for cyclosporin-induced encephalopathy remain controversial. Herein we present a case of cyclosporin-induced encephalopathy with unusually prolonged vasospasm, which might have contributed to the slow recovery of the patient.