Scedosporium apiospermum brain abscesses in a patient receiving ibrutinib and venetoclax

Figueroa, Rocio; Martinez‐Calle, Nicolas; Prescott, Katie; Bishton, Mark

Abstract

An 80-year-old male, with relapsed mantle cell lymphoma was treated on a trial with the combination of the bruton tyrosine kinase (BTK) inhibitor, ibrutinib, and BH3-mimetic, venetoclax, and achieved complete remission by both Computerized Tomography-Positron Emission Tomography (CT-PET) and molecular assessment. Despite a persistent mild neutropenia noted at study visits, which did not require drug interruption or Granulocyte-colony stimulating factor (GCSF) by protocol, he had a normal IgG level and had not suffered any infectious complications during 2 years of therapy. Following a fall at home, he presented to hospital with confusion. CT and Magnetic Resonance Imaging (MRI) head demonstrated multifocal right frontal lobe brain abscesses requiring urgent neurosurgical drainage (Figure 1A). Scedosporium apiospermum was cultured from pus (Figure 1B). The isolate was sent to the Public Health England mycology reference laboratory where in vitro sensitivity to amphotericin B and voriconazole was demonstrated. The patient had no other attributable risk factors such as near drowning or prolonged steroid therapy. CT-PET did not demonstrate any evidence of systemic fungal infection and confirmed ongoing metabolic remission. Both ibrutinib and venetoclax therapy were discontinued and the patient was commenced on therapeutic voriconazole, with close therapeutic drug monitoring. Clinical and radiological improvement was observed, and the patient remains clinically well 4 months later.

Citation

Figueroa, R., Martinez‐Calle, N., Prescott, K., & Bishton, M. (2020). Scedosporium apiospermum brain abscesses in a patient receiving ibrutinib and venetoclax. eJHaem, 1(2), 418-419. https://doi.org/10.1002/jha2.121

• Journal Article Type: Article
• Acceptance Date: Oct 13, 2020
• Online Publication Date: Oct 26, 2020
• Publication Date: 2020-11
• Deposit Date: Aug 1, 2023
• Publicly Available Date: Aug 21, 2023
• Journal: eJHaem
• Electronic ISSN: 2688-6146
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 1
• Issue: 2
• Pages: 418-419
• DOI: https://doi.org/10.1002/jha2.121
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/23550440
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/jha2.121
• PMID: 35844985