RESUMEN
Carmustine wafers can be implanted in the surgical bed of high-grade gliomas, which can induce surgical bed cyst formation, leading to clinically relevant mass effect. An observational retrospective monocentric study was conducted including 122 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent a surgical resection with Carmustine wafer implantation as first line treatment (2005-2018). Twenty-two patients (18.0%) developed a postoperative contrast-enhancing cyst within the surgical bed: 16 surgical bed cysts and six bacterial abscesses. All patients with a surgical bed cyst were managed conservatively, all resolved on imaging follow-up, and no patient stopped the radiochemotherapy. Independent risk factors of formation of a postoperative surgical bed cyst were age ≥ 60 years (p = 0.019), number of Carmustine wafers implanted ≥ 8 (p = 0.040), and partial resection (p = 0.025). Compared to surgical bed cysts, the occurrence of a postoperative bacterial abscess requiring surgical management was associated more frequently with a shorter time to diagnosis from surgery (p = 0.009), new neurological deficit (p < 0.001), fever (p < 0.001), residual air in the cyst (p = 0.018), a cyst diameter greater than that of the initial tumor (p = 0.027), and increased mass effect and brain edema compared to early postoperative MRI (p = 0.024). Contrast enhancement (p = 0.473) and diffusion signal abnormalities (p = 0.471) did not differ between postoperative bacterial abscesses and surgical bed cysts. Clinical and imaging findings help discriminate between surgical bed cysts and bacterial abscesses following Carmustine wafer implantation. Surgical bed cysts can be managed conservatively. Individual risk factors will help tailor their steroid therapy and imaging follow-up.
Asunto(s)
Absceso Encefálico , Neoplasias Encefálicas , Quistes , Glioblastoma , Adulto , Antineoplásicos Alquilantes/uso terapéutico , Absceso Encefálico/inducido químicamente , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/cirugía , Carmustina/efectos adversos , Quistes/inducido químicamente , Quistes/tratamiento farmacológico , Glioblastoma/tratamiento farmacológico , Glioblastoma/cirugía , Humanos , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Absceso Encefálico/inducido químicamente , Factores Inmunológicos/efectos adversos , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Natalizumab/efectos adversos , Infecciones Estreptocócicas/inducido químicamente , Adulto , Absceso Encefálico/microbiología , Humanos , Masculino , Streptococcus anginosusRESUMEN
Surgical-site infection, spinal cord abscess, and catheter tip granuloma are known but rare complications of intrathecal drug delivery systems (IDDS). To date, there are no published cases of brain abscess in a patient with an IDDS. In this study, we report a case of a cancer patient with an IDDS for management of cancer pain who developed a brain abscess with profound mental status changes and clinical management challenges.
Asunto(s)
Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Absceso Encefálico/inducido químicamente , Absceso Encefálico/terapia , Dolor en Cáncer/tratamiento farmacológico , Sistemas de Liberación de Medicamentos/normas , Inyecciones Espinales/normas , Humanos , Guías de Práctica Clínica como Asunto , Estudios RetrospectivosRESUMEN
We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, forehead swelling, a subdural empyema and osteomyelitis of the frontal bone. She was treated with a rhinosurgical and neurosurgical approach with intravenous antibiotics.Patient 2 had been in adalimumab treatment for 10 weeks. Adalimumab was discontinued 8 weeks prior to developing subdural empyema and subcortical abscesses in combination with sinusitis. She was treated with endoscopic sinus surgery and intravenous antibiotics. Both patients had developed psoriasis and episodes of infection during treatment. They were non-septic and had low fever on presentation. None of the patients suffered any long-term neurological sequelae. The immunosuppressive treatment with adalimumab is considered to be the cause of the sinogenic intracranial complications in our cases.
Asunto(s)
Adalimumab/efectos adversos , Antiinflamatorios/efectos adversos , Encefalopatías/inducido químicamente , Osteomielitis/tratamiento farmacológico , Sinusitis/inducido químicamente , Absceso/inducido químicamente , Enfermedad Aguda , Absceso Encefálico/inducido químicamente , Niño , Empiema Subdural/inducido químicamente , Femenino , Humanos , Enfermedades Orbitales/inducido químicamenteRESUMEN
Bacillus Calmette-Guérin (BCG) is a live, attenuated strain of Mycobacterium bovis that is used to treat superficial bladder cancer. Although its use is typically associated with only mild, localized side effects, rare systemic complications can occur. Disseminated mycobacterium infections after BCG therapy have been reported in over 30 cases; however, central nervous system (CNS) infections do not commonly occur. We report a 74-year-old male who developed a M. bovis cerebellar abscess after receiving intravesical BCG infusion for bladder cancer for less than 1 year. This patient was successfully treated with antituberculosis therapy and corticosteroids. This patient case demonstrates that early-onset M bovis CNS infections can occur after BCG therapy. Patients presenting with altered mental status while on BCG therapy should be evaluated for disseminated infections.
Asunto(s)
Vacuna BCG/efectos adversos , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/metabolismo , Cerebelo/diagnóstico por imagen , Cerebelo/microbiología , Mycobacterium bovis/aislamiento & purificación , Anciano , Absceso Encefálico/inducido químicamente , Humanos , Masculino , Resultado del TratamientoRESUMEN
We present the case of a 3-year-old boy who was diagnosed with cerebral abscesses due to Aspergillus nidulans infection on day 28 of induction chemotherapy for acute lymphoblastic leukemia. He responded well to treatment with voriconazole and caspofungin, making a full recovery. There are very few cases of invasive aspergillosis reported in children during induction chemotherapy for acute leukemia and A. nidulans is rare in the absence of chronic granulomatous disease.
Asunto(s)
Aspergilosis/tratamiento farmacológico , Absceso Encefálico/tratamiento farmacológico , Equinocandinas/uso terapéutico , Quimioterapia de Inducción/efectos adversos , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Voriconazol/uso terapéutico , Antifúngicos/uso terapéutico , Aspergilosis/inducido químicamente , Aspergilosis/microbiología , Aspergillus nidulans/patogenicidad , Absceso Encefálico/inducido químicamente , Absceso Encefálico/microbiología , Caspofungina , Preescolar , Humanos , Lipopéptidos , Enfermedades Pulmonares Fúngicas/inducido químicamente , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , PronósticoRESUMEN
BACKGROUND: Immunocompromised patients are at increased risk for developing meningitis or, rarely, brain abscess with opportunistic organisms like Listeria monocytogenes. CASE REPORT: A 52 year-old Saudi Arabian woman who was diagnosed with pemphigus vulgaris and diabetes and had been on prednisolone and azathioprine for about 4 years. She presented with headache, low-grade fever, and left-sided weakness 2 weeks after receiving the second dose of rituximab infusion. Magnetic resonance imaging revealed an enhanced space-occupying lesion with multiple small cyst-like structures and vasogenic edema in the right temporoparietal area. Her blood culture was positive for Listeria monocytogenes, and a brain biopsy showed necrotic tissues with pus and inflammatory cells. She recovered after a 6-week course of antibiotics with ampicillin and gentamycin. CONCLUSIONS: Brain abscess due to Listeria monocytogenes is a risk that should be considered when adding rituximab to the regimen of a patient who is already Immunocompromised.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino/efectos adversos , Absceso Encefálico/inducido químicamente , Pénfigo/complicaciones , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Antígenos CD20 , Absceso Encefálico/diagnóstico , Femenino , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Infusiones Intravenosas , Imagen por Resonancia Magnética , Persona de Mediana Edad , RituximabRESUMEN
Nocardial brain abscess is a rare but severe complication in patients with malignancy. Nocardia exalbida was isolated in Japan and characterized within the genus Nocardia. We present the first report of N. exalbida brain abscess in a 63-year-old male patient with follicular lymphoma. He developed abnormal neurological findings during follicular lymphoma treatment, brain CT revealed ring-enhancing, multiloculated lesions, and N. exalbida was detected by aspiration of the lesion. He was successfully treated with trimethoprime-sulfamethoxazole (TMP-SMX) and meropenem without craniotomy or repeat aspirations. It should be noted that such an infection can occur in patients treated with conventional chemotherapy against malignant lymphoma.
Asunto(s)
Antibacterianos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Absceso Encefálico/tratamiento farmacológico , Linfoma Folicular/tratamiento farmacológico , Nocardiosis/tratamiento farmacológico , Nocardia , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Absceso Encefálico/inducido químicamente , Absceso Encefálico/microbiología , Absceso Encefálico/patología , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Humanos , Linfoma Folicular/microbiología , Linfoma Folicular/patología , Masculino , Persona de Mediana Edad , Nocardiosis/inducido químicamente , Nocardiosis/patología , Prednisona/administración & dosificación , Prednisona/efectos adversos , Inducción de Remisión , Vincristina/administración & dosificación , Vincristina/efectos adversosRESUMEN
Invasive fungal infections remain a life threatening complication in children with hematological malignancies. The brain represents a common site of hematogenously disseminated infections from an extracranial focus. We report our experience in the diagnosis, radiological aspects and therapeutic approach of fungal brain abscesses in 2 children receiving chemotherapy for acute lymphoblastic leukemia (ALL).
Asunto(s)
Antineoplásicos/efectos adversos , Absceso Encefálico/inducido químicamente , Meningitis Criptocócica/inducido químicamente , Neuroaspergilosis/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/patología , Preescolar , Resultado Fatal , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/patología , Neuroaspergilosis/tratamiento farmacológico , Neuroaspergilosis/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicacionesRESUMEN
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.
Asunto(s)
Antineoplásicos Alquilantes/efectos adversos , Absceso Encefálico/inducido químicamente , Neoplasias Encefálicas/tratamiento farmacológico , Dacarbazina/análogos & derivados , Glioblastoma/tratamiento farmacológico , Listeriosis/inducido químicamente , Pneumocystis carinii , Neumonía por Pneumocystis/inducido químicamente , Sarcoma de Kaposi/inducido químicamente , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/patología , Neoplasias Encefálicas/cirugía , Dacarbazina/efectos adversos , Glioblastoma/cirugía , Humanos , Listeriosis/tratamiento farmacológico , Listeriosis/patología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/efectos adversos , Neumonía por Pneumocystis/tratamiento farmacológico , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/patología , TemozolomidaAsunto(s)
Antineoplásicos/efectos adversos , Absceso Encefálico/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adolescente , Absceso Encefálico/microbiología , Infecciones por Escherichia coli/inducido químicamente , Resultado Fatal , Hemoptisis , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Infecciones por Pseudomonas/inducido químicamente , Inducción de RemisiónRESUMEN
In a 19-year old man a loculated brain abscess developed in a contusional lesion subsequent to head injury. He remained an inpatient at the hospital during the entire time from trauma to operation. The patient had received dexamethasone because of elevated intracranial pressure, and he was supervised via computerised tomography. Besides pre-operative differential diagnosis, the pathogenesis of this septic complication caused by steroids without antibiotics is discussed in the light of recent literature.
Asunto(s)
Absceso Encefálico/inducido químicamente , Conmoción Encefálica/complicaciones , Edema Encefálico/tratamiento farmacológico , Dexametasona/efectos adversos , Infecciones Estafilocócicas/inducido químicamente , Adulto , Absceso Encefálico/cirugía , Dexametasona/uso terapéutico , Humanos , Masculino , Riesgo , Infecciones Estafilocócicas/cirugíaRESUMEN
A case of acute brain abscess in a 59-year-old man is presented. The primary CT findings were misinterpreted as a brain infarct or possibly a tumour. Under steroid therapy an activation of the brain abscess was observed in only nine days and in spite of an immediate operation the patient died.