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Brain Abscess following Rituximab Infusion in a Patient with Pemphigus Vulgaris

Talal M. Al-Harbi, Shahad A. Al-Muammar, Ronald J. Ellis

(Department of Neurology, Neuroscience Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia)

Am J Case Rep 2015; 16:65-68

DOI: 10.12659/AJCR.892635

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.

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