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Published on: August 9, 2011
Listeria monocytogenes Bacteremia During Isatuximab Therapy in a Patient with Multiple Myeloma
Toshiyuki Ueno1, Takanori Ohta1, Hiroshi Imanaga2
1Department of Hematology, Kitakyushu Municipal Medical Center, Japan.
Abstract:
An elderly patient with multiple myeloma (MM) was being treated with several regimens and developed a severe drug eruption, necessitating the use of atovaquone instead of trimethoprim-sulfamethoxazole for pneumocystis pneumonia (PCP) prophylaxis. For progressive MM, treatment with isatuximab, an anti-CD38 monoclonal antibody, was started. During the treatment, he developed Listeria monocytogenes bacteremia and recovered quickly with ampicillin administration. CD38 is closely related to the innate immune response against L. monocytogenes, and isatuximab may increase the risk of infection. Therefore, trimethoprim-sulfamethoxazole may be useful in the prevention of not only PCP but also L. monocytogenes infection.
Insights
Trimethoprim-sulfamethoxazole may prevent infections in multiple myeloma patients. This antibiotic is effective against Pneumocystis pneumonia and Listeria monocytogenes, especially during anti-CD38 therapy.
Area of Science:
- Oncology
- Infectious Diseases
- Immunology
Background:
- Multiple myeloma (MM) treatment requires careful management of opportunistic infections.
- Pneumocystis pneumonia (PCP) prophylaxis is standard in immunocompromised patients.
- Drug eruptions can complicate standard prophylactic regimens.
Observation:
- An elderly MM patient developed a severe drug eruption, requiring a switch from trimethoprim-sulfamethoxazole to atovaquone for PCP prophylaxis.
- The patient later received isatuximab, an anti-CD38 monoclonal antibody, for progressive MM.
- Subsequently, the patient experienced Listeria monocytogenes bacteremia, which resolved with ampicillin.
Findings:
- CD38 plays a role in the innate immune response against Listeria monocytogenes.
- Isatuximab therapy may be associated with an increased risk of Listeria monocytogenes infection.
- The patient's clinical course suggests a potential dual role for trimethoprim-sulfamethoxazole.
Implications:
- Trimethoprim-sulfamethoxazole could be considered for prophylaxis against both PCP and Listeria monocytogenes in MM patients undergoing anti-CD38 therapy.
- This highlights the importance of considering alternative prophylactic agents and potential infection risks associated with targeted therapies.
- Further research is warranted to confirm the efficacy of trimethoprim-sulfamethoxazole in preventing Listeria monocytogenes infections in this patient population.
