Contributions
Abstract: PB2013
Type: Publication Only
Background
The proteosome inhibitors and immunmodulatory drugs which are used in MM treatment enhance the risk of infection by several mechanisms.Nocardial infections are rare in Turkey.
Aims
Here,we present three relapsed myeloma cases which developed nocardia pneumonia.
Methods
Case-1 :66 year old man, who has a history of autologous SCT 4 years ago and lenalidomide usage because of IgG kappa type myeloma, has been prescribed bortezomibe for the relapse of the disease.He was immunocompromised not only because of the myeloma, and also because of the diabetes and renal failure without dialysis. He was admitted to the hospital because of the productive cough.His lymphocyte count was 1290/mm3 and flow-cytometric analysis showed CD5:%68 and CD20:%2. Thorax CT showed 39x39x45 mm mass like lesion.Broncoscopic lavage examination showed branched bacillus via modified acid-fast and Gram stain.This typical morphological appearence was defined as Nocardia spp. Imipenem/cilastatin treatment started and control CT was performed after ten days and it showed regression of the infiltration.He was discharged with oral TMP/SMX antibiotherapy.
Results
Genereal features of the cases | Case -1 | Case-2 | Case-3 |
Age | 66 | 71 | 72 |
Gender | Male | Female | Male |
Lymphocyte Count(/mm3) | 1290 | 2300 | 520 |
Myeloma Type | IgG kappa | IgG kappa | IgG kappa |
Previous Treatment | Autologous SCT 4 years ago Lenalidomide-Dexamethasone | Autologous SCT 5 and 12 years ago Bortezomibe-Thalidomide-Dexamethasone | Autologous SCT 4 years ago Bortezomibe-Thalidomide-Dexamethasone |
Recent Treatment Before Nocardiosis | Bortezomibe | Pomalidomide | Bortezomibe-Thalidomide-Dexamethasone |
Conclusion
The proteosome inhibitors and immunmodulatory drugs which are used for the treatment of MM;make T cell disfunction and considering B cell disfunction is also present because of the nature of the disease;this situation tends to provoke rare opportunistic infections such as nocardiosis.Thus,in these patients;it is significant to follow the lymphocyte count closely and to keep in mind that kind of rare microorganisms.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Abstract: PB2013
Type: Publication Only
Background
The proteosome inhibitors and immunmodulatory drugs which are used in MM treatment enhance the risk of infection by several mechanisms.Nocardial infections are rare in Turkey.
Aims
Here,we present three relapsed myeloma cases which developed nocardia pneumonia.
Methods
Case-1 :66 year old man, who has a history of autologous SCT 4 years ago and lenalidomide usage because of IgG kappa type myeloma, has been prescribed bortezomibe for the relapse of the disease.He was immunocompromised not only because of the myeloma, and also because of the diabetes and renal failure without dialysis. He was admitted to the hospital because of the productive cough.His lymphocyte count was 1290/mm3 and flow-cytometric analysis showed CD5:%68 and CD20:%2. Thorax CT showed 39x39x45 mm mass like lesion.Broncoscopic lavage examination showed branched bacillus via modified acid-fast and Gram stain.This typical morphological appearence was defined as Nocardia spp. Imipenem/cilastatin treatment started and control CT was performed after ten days and it showed regression of the infiltration.He was discharged with oral TMP/SMX antibiotherapy.
Results
Genereal features of the cases | Case -1 | Case-2 | Case-3 |
Age | 66 | 71 | 72 |
Gender | Male | Female | Male |
Lymphocyte Count(/mm3) | 1290 | 2300 | 520 |
Myeloma Type | IgG kappa | IgG kappa | IgG kappa |
Previous Treatment | Autologous SCT 4 years ago Lenalidomide-Dexamethasone | Autologous SCT 5 and 12 years ago Bortezomibe-Thalidomide-Dexamethasone | Autologous SCT 4 years ago Bortezomibe-Thalidomide-Dexamethasone |
Recent Treatment Before Nocardiosis | Bortezomibe | Pomalidomide | Bortezomibe-Thalidomide-Dexamethasone |
Conclusion
The proteosome inhibitors and immunmodulatory drugs which are used for the treatment of MM;make T cell disfunction and considering B cell disfunction is also present because of the nature of the disease;this situation tends to provoke rare opportunistic infections such as nocardiosis.Thus,in these patients;it is significant to follow the lymphocyte count closely and to keep in mind that kind of rare microorganisms.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical