Skip to main content

Advertisement

SpringerLink
Log in

Brain abscess caused by Micrococcus luteus in a patient with systemic lupus erythematosus: case-based review

  • Cases with a Message
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Central nervous system infections, which are rarely seen in systemic lupus erythematosus (SLE), have considerably high mortality but they are difficult to distinguish from neuropsychiatric manifestation of lupus. This article reports the case of a patient with SLE with brain abscess which developed during immunosuppressive therapy for lupus nephritis. The patient completely recovered without neurological sequelae by open surgical drainage and 12-week antibiotic therapy. It is recommended that CNS infections must be excluded in patients with SLE, particularly who are receiving immunosuppressive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ospina FE, Echeverri A, Zambrano D, Suso JP, Martínez-Blanco J, Cañas CA, Tobón GJ (2017) Distinguishing infections vs flares in patients with systemic lupus erythematosus. Rheumatology;56 (suppl_1):i46–i54. https://doi.org/10.1093/rheumatology/kew340

    Article  CAS  PubMed  Google Scholar 

  2. Danza A, Ruiz-Irastorza G (2013) Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus 22:1286–1294. https://doi.org/10.1177/0961203313493032

    Article  CAS  PubMed  Google Scholar 

  3. Horta-Baas G, Guerrero-Soto O, Barile-Fabris L (2013) Central nervous system infection by listeria monocytogenes in patients with systemic lupus erythematosus: analysis of 26 cases, including the report of a new case. Reumatol Clin 9(6):340–347. https://doi.org/10.1016/j.reuma.2013.04.011

    Article  PubMed  Google Scholar 

  4. Yang CD, Wang XD, Ye S, Gu YY, Bao CD, Wang Y, Chen SL (2007) Clinical features, prognostic and risk factors of central nervous system infections in patients with systemic lupus erythematosus. Clin Rheumatol 26:895–901. https://doi.org/10.1007/s10067-006-0424-x

    Article  PubMed  Google Scholar 

  5. Vargas PJ, King G, Navarra SV (2009) Central nervous system infections in filipino patients with systemic lupus erythematosus. Int J Rheum Dis 12(3):234–238. https://doi.org/10.1111/j.1756-185X.2009.01416.x

    Article  PubMed  Google Scholar 

  6. David JHetem, Suzan HM, Rooijakkers, Miquel BEkkelenkamp (2017) Staphylococci and Micrococci. In: Jonathan Cohen WG, Powderly, Opal SM (eds) Infectious diseases, 4th edn, Volume 2, pp 1509–1522

  7. Jeong JH, Moon SM, Park PW, Ahn JY, Kim KH, Seo JY, Lee HT, Jae KW, Seo YH (2017) multiple brain abscesses caused by Nocardia asiatica in a patient with systemic lupus erythematosus: the first case report and literature review. Ann Lab Med 37(5):459–461. https://doi.org/10.3343/alm.2017.37.5.459

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sakarunchai I, Saeheng S, Oearsakul T, Sanghan N (2016) Listeria monocytogenes brain abscess on MR imaging mimicking the track of a migrating worm like a sparganum: a case report. Interdiscipl Neurosurg 5:9–11. https://doi.org/10.1016/j.inat.2016.03.008

    Article  Google Scholar 

  9. Perini G, Pravettoni R, Farina E, Grande G, Contri P, Mariani C (2015) Listeria brain abscesses during administration of mycophenolate mofetil for systemic lupus erythematosus: a case report. Neurol Sci 36(6):1019–1020. https://doi.org/10.1007/s10072-014-1969-0

    Article  PubMed  Google Scholar 

  10. Ueda Y, Yamamoto K, Watanabe K, Yamashita H, Ohmagari N, Mimori A (2014) Obstructive pneumonia and brain abscess due to Nocardia elegans in a patient with systemic lupus erythematosus. Kansenshogaku Zasshi 88(3):282–287. (Japanase)

    Article  Google Scholar 

  11. Prasad BNS, Misra R, Agarwal V, Lawrence A, Aggarwal A (2014) Nocardia infection in SLE: a case series of three patients. Indian J Rheumatol 9(2):53–56. https://doi.org/10.1016/j.injr.2014.02.004

    Article  Google Scholar 

  12. Fei Y, Shi X, Gan F, Li X, Zhang W, Li M, Hou Y, Zhang X, Zhao Y, Zeng X, Zhang F (2014) Death causes and pathogens analysis of systemic lupus erythematosus during the past 26 years. Clin Rheumatol 33:57–63. https://doi.org/10.1007/s10067-013-2383-3

    Article  PubMed  Google Scholar 

  13. Xu Y, Xu D, Zhang T, Leng X-M, Zhang F-C, Zeng X-F (2012) The prevalence and clinical characteristics of systemic lupus erythematosus with infectious brain lesions in China. Scand J Rheumatol 41:466–471. https://doi.org/10.3109/03009742.2012.680607

    Article  CAS  PubMed  Google Scholar 

  14. Baizabal-Carvallo JF, Delgadillo-Márquez G, Estañol B, García-Ramos G (2009) Clinical characteristics and outcomes of the meningitides in systemic lupus erythematosus. Eur Neurol 61:143–148. https://doi.org/10.1159/000186504

    Article  PubMed  Google Scholar 

  15. .Cone LA, Somero MS, Qureshi FJ, Kerkar S, Byrd RG, Hirschberg JM, Gauto AR (2008) Unusual infections due to Listeria monocytogenes in the Southern California desert. Int J Infect Dis 12:578–581. https://doi.org/10.1016/j.ijid.2007.12.003

    Article  PubMed  Google Scholar 

  16. Hernández-Belmonte A, Mateos-Rodríguez F, Andrés-Mompean E, PalomarPérez J (2008) Bacteremia, absceso cerebral y meningitis por Listeria monocytogenes. Enferm Infecc Microbiol Clin 26:318–319. https://doi.org/10.1157/13120425

    Article  PubMed  Google Scholar 

  17. Amr SS, Al-Tawfiq JA (2007) Aspiration cytology of brain abscess from a fatal case of cerebral phaeohyphomycosis due to Ramichloridium mackenziei. Diagn Cytopathol 35(11):695–699. https://doi.org/10.1002/dc.20724

    Article  PubMed  Google Scholar 

  18. Justiniano M, Glorioso S, Dold S, Espinoza LR (2007) Nocardia brain abscesses in a male patient with SLE: successful outcome despite delay in diagnosis. Clin Rheumatol 26(6):1020–1022. https://doi.org/10.1007/s10067-006-0262-x

    Article  PubMed  Google Scholar 

  19. Kilincer C, Hamamcioglu MK, Simsek O, Hicdonmez T, Aydoslu B, Tansel O, Tiryaki M, Soy M, Tatman-Otkun M, Cobanoglu S (2006) Nocardial brain abscess: review of clinical management. J Clin Neurosci 13(4):481–485. https://doi.org/10.1016/j.jocn.2005.04.031

    Article  PubMed  Google Scholar 

  20. Geramishoar M, Zomorodian K, Zaini F, Saadat F, Tarazooie B, Norouzi M, Rezaie S (2004) First case of cerebral phaeohyphomycosis caused by Nattrassia mangiferae in Iran. Jpn J Infect Dis 57(6):285–286

    PubMed  Google Scholar 

  21. Yoneyama T, Yamakami I, Mine S, Saeki N, Yamaura A, Ozaki H, Nakazaki M (2004) [Nocardial brain abscess: surgery and postoperative antibiotic therapy]. No Shinkei Geka 32(5):457–462. (Japanese)

    PubMed  Google Scholar 

  22. Inamasu J, Nakamura Y, Saito R (2003) Ring-enhanced mass in the brain of a woman with systemic lupus erythematosus and elevated serum CA19-9 level: brain abscess or metastatic tumor?—case report. Neurol Med Chir (Tokyo) 43(1):43–46

    Article  Google Scholar 

  23. Raut A, Muzumdar D, Narlawar R, Nagar A, Ahmed N, Hira P (2003) Cerebral abscess caused by Cladosporium bantianum infection-case report. Neurol Med Chir (Tokyo) 43(8):413–415. https://doi.org/10.2176/nmc.43.413

    Article  Google Scholar 

  24. AlHabib KF, Bryce EA (2003) Xylohypha bantiana multiple brain abscesses in a patient with systemic lupus erythematosus. Can J Infect Dis 14(2):119–120

    Article  Google Scholar 

  25. Eckburg PB, Montoya JG, Vosti KL (2001) Brain abscess due to Listeria monocytogenes: five cases and a review of the literature. Medicine (Baltimore) 80:223–235

    Article  CAS  Google Scholar 

  26. Takano A, Adachi H, Mizuno M, Kawamura K, Sobue G (1999) Direct gram staining of blood culture sample enabled the early diagnosis of brain abscess due to Listeria monocytogenes. Clin Neurol 39(11):1164–1167

    CAS  Google Scholar 

  27. Huang JL, Chou ML, Hung IJ, Hsieh KH (1996) Multiple cryptococcal brain abscesses in systemic lupus erythematosus. Br J Rheumatol 35(12):1334–1335

    Article  CAS  Google Scholar 

  28. Escobar A, Del Brutto OH (1990) Multiple brain abscesses from isolated cerebral mucormycosis. J Neurol Neurosurg Psychiatry 53(5):431–433

    Article  CAS  Google Scholar 

  29. Nishimoto Y, Ohno T, Kawabata Y (1980) An autopsy case of SLE with multiple brain abscess. J Wakayama Med Soc 31(4):383–393

    Google Scholar 

  30. Forno LS, Billingham ME (1972) Allescheria boydii infection of the brain. J Pathol 106(3):195–198

    Article  CAS  Google Scholar 

  31. Tay SH, Mak A (2017) Diagnosing and attributing neuropsychiatric events to systemic lupus erythematosus: time to untie the Gordian knot? Rheumatology 56(suppl_1):i14-i23. https://doi.org/10.1093/rheumatology/kew338

    Article  PubMed  Google Scholar 

  32. Patel K, Clifford DB (2014) Bacterial brain abscess. Neurohospitalist 4(4):196–204. https://doi.org/10.1177/1941874414540684

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chowdhury FH, Haque MR, Sarkar MH, Chowdhury SM, Hossain Z, Ranjan S (2015) Brain abscess: surgical experiences of 162 cases. Neuroimmunol Neuroinflammation 2(3):153–161. https://doi.org/10.4103/2347-8659.160851

    Article  Google Scholar 

  34. Fang H, Lan L, Qu Y, Zhang Q, Lv J (2018) Differences between central nervous system infection and neuropsychiatric systemic lupus erythematosus in patients with systemic lupus erythematosus. J Int Med Res 46(1):485–491. https://doi.org/10.1177/0300060517722695

    Article  PubMed  Google Scholar 

  35. Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR (2013) Brain abscess: Current management. J Neurosci Rural Pract 4(Suppl 1):S67–S81. https://doi.org/10.4103/0976-3147.116472

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

I would like to thank Enago for assistance in English language editing.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Akdeniz University, Antalya, Turkey

    Funda Erbasan

Authors
  1. Funda Erbasan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FE designed, reviewed the literature, and wrote the manuscript.

Corresponding author

Correspondence to Funda Erbasan.

Ethics declarations

Conflict of interest

The author declares that they have no competing interests.

Informed consent

An informed consent was obtained from the patient for publication.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erbasan, F. Brain abscess caused by Micrococcus luteus in a patient with systemic lupus erythematosus: case-based review. Rheumatol Int 38, 2323–2328 (2018). https://doi.org/10.1007/s00296-018-4182-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-018-4182-2

Keywords

Search

Navigation