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Published on: November 5, 2019
Unexpected pathogen presenting with purulent meningitis
Jamie Bering1, Carlos Hartmann2, Kara Asbury2
1Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Abstract:
Herein we report a case of a 67-year-old man with chronic lymphocytic leukaemia who developed acute onset of fever and altered mental status while receiving ibrutinib therapy. He was eventually found to have Capnocytophaga canimorsus meningitis. Timely diagnosis and appropriate antimicrobial therapy was associated with a favourable outcome. We describe challenges associated with appropriate identification of, and briefly review infections caused by Capnocytophaga sp. To our knowledge, this is the first case of invasive C. canimorsus infection in the setting of ibrutinib therapy, and adds to the growing list of serious infections that have been associated with this agent.
Insights
A man with chronic lymphocytic leukaemia developed Capnocytophaga canimorsus meningitis while on ibrutinib therapy. Prompt diagnosis and treatment led to a positive outcome, highlighting a rare but serious infection risk.
Area of Science:
- Infectious Diseases
- Oncology
- Neurology
Background:
- Chronic lymphocytic leukaemia (CLL) is a common hematologic malignancy.
- Ibrutinib is a targeted therapy used for CLL and other B-cell malignancies.
- Patients on targeted therapies may be at increased risk for opportunistic infections.
Observation:
- A 67-year-old man with CLL on ibrutinib presented with acute fever and altered mental status.
- Cerebrospinal fluid analysis revealed Capnocytophaga canimorsus meningitis.
- The patient's symptoms developed during ibrutinib treatment.
Findings:
- This is the first reported case of invasive Capnocytophaga canimorsus meningitis in a patient receiving ibrutinib.
- Capnocytophaga canimorsus is a bacterium typically associated with dog or cat bites.
- Timely diagnosis and appropriate antimicrobial therapy resulted in a favorable outcome.
Implications:
- Ibrutinib therapy may increase the risk of invasive Capnocytophaga canimorsus infections.
- Clinicians should consider Capnocytophaga species in the differential diagnosis of meningitis in immunocompromised patients, especially those on ibrutinib.
- Early recognition and treatment are crucial for managing these serious infections.
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