Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide.
Nature Clinical Practice. Oncology
339-343; quiz following 343
Publication types: Case Reports ; Journal Article
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.
Antineoplastic Agents, Alkylating, Brain Abscess, Brain Neoplasms, Dacarbazine, Glioblastoma, Humans, Listeria Infections, Male, Middle Aged, Neoadjuvant Therapy, Pneumocystis jirovecii, Pneumonia, Pneumocystis, Sarcoma, Kaposi
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