Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Abstract

BACKGROUND Systemic lupus erythematosus (SLE) patients are extremely susceptible toopportunistic infections due to glucocorticoid and immunosuppressive treatments, which often occur in the respiratory system, the urinary system and theskin. However, multiple cerebral infections are rarely reported and their treatment is not standardized, especially when induced by a rare pathogen.CASE SUMMARYA 46-year-old woman was treated with glucocorticoid and immunosuppressantfor SLE involving the hematologic system and kidneys (class IV-G lupusnephritis) for more than one year. She was admitted to hospital due to headacheand fever, and was diagnosed with multiple cerebral abscesses. Brain enhancedmagnetic resonance imaging showed multiple nodular abnormal signals in bothfrontal lobes, left parietal and temporal lobes, left masseteric space (left temporalisand masseter region). The initial surgical plan was only to remove the largeabscesses in the left parietal lobe and right frontal lobe. After surgery, based onthe drug susceptibility test results (a rare pathogen Nocardia asteroides was found)and taking into consideration the patient’s renal dysfunction, a multi-antibioticregimen was selected for the treatment. The immunosuppressant mycophenolatemofetil was discontinued on admission and the dose of prednisone was reduced from 20 mg/d to 10 mg/d. Re-examination at 3 mo post-surgery showed that the intracranial lesions were reduced, the edema around the lesions was absorbed and dissipated, and her neurological symptoms had disappeared. The patient had no headaches or other neurological symptoms and lupus nephritis was stable during the 2-year follow-up period. CONCLUSION In this report, we provide reasonable indications for immunosuppression, anti-infective therapy and individualized surgery for an SLE patient complicated with multiple cerebral abscesses caused by a rare pathogen, which may help improve the diagnosis and treatment of similar cases.