A case of central nervous system nocardiosis in a patient with lupus treated with belimumab

Nocardiosis in rheumatic patients: Case series and review of literature

“…For instance, two of our three patients received prednisone of 10 mg/day at the time of admission. Besides, nocardiosis has also been reported in patients given rituximab, etanercept, and abatacept 4–7 . For another, as shown in our laboratory data, two of our three patients had reduced absolute lymphocyte values, one of our three patients had reduced IgG, and one out of two patients had elevated CD4 + /CD8 + ratio.…”

Chronic relapsing neutrophilic meningitis as the sole manifestation of nocardiosis in a patient with mixed connective tissue disease

“…In the diagnosis and management of chronic meningitis, great emphasis should be placed on conducting a meticulous analysis of epidemiological and clinical findings as early pathogen identification, particularly in the context of opportunistic organisms, frequently results in favorable outcomes [10] , [13] . In a review of the connective tissue disease population, primary non-relapsing Nocardia meningitis is limited to two patients with systemic lupus erythematosus, one with chronic meningitis not responsive to antibiotics in which the diagnosis was made post-mortem and the other associated with the use of belimumab and mycophenolate [6] , [7] .…”

“…Due to the highly variable clinical manifestations associated with Nocardial infections, diagnostic and therapeutic challenges are commonly encountered that, if not recognized and addressed early and appropriately, may result in high levels of morbidity and mortality [2] , [3] . Nocardia meningitis in the absence of a cerebral abscess, trauma or extracranial foci is extremely rare with only seven well-documented cases reported in the English literature [4] , [5] , [6] , [7] . We describe a patient with polymyositis-predominant mixed connective tissue disease (MCTD), well-controlled on hydroxychloroquine and chronic glucocorticoid therapy, who was hospitalized on five occasions over five consecutive months due to relapsing neutrophilic meningitis.…”

Case report: A systemic lupus erythematosus patient with Tropheryma whipplei infection

“…Therefore, we investigated the role of immunosuppressive and biological agents in TW infection. Central nervous system nocardiosis 3 and progressive multifocal leukoencephalopathy caused by JC virus infection 4 have previously been reported in patients with SLE treated with beliuzumab. However, there are no reports of TW infections in patients with SLE on belimumab treatment.…”