Post colonoscopic <i>Listeria monocytogenes</i> meningitis in a patient with multiple myeloma during daratumumab-based therapy

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  • HORIKITA Fuka
    Department of Internal Medicine/General Medicine, Japanese Red Cross Kitami Hospital
  • HASHIGUCHI Junichi
    Department of Internal Medicine/General Medicine, Japanese Red Cross Kitami Hospital
  • NAGASHIMA Takahiro
    Department of Internal Medicine/General Medicine, Japanese Red Cross Kitami Hospital

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Other Title
  • 下部消化管内視鏡後に<i>Listeria</i>髄膜炎を合併したdaratumumab併用療法中の多発性骨髄腫
  • 症例報告 下部消化管内視鏡後にListeria髄膜炎を合併したdaratumumab併用療法中の多発性骨髄腫
  • ショウレイ ホウコク カブ ショウカカン ナイシキョウ ゴ ニ Listeria ズイマクエン オ ガッペイ シタ daratumumab ヘイヨウ リョウホウ チュウ ノ タハツセイ コツズイシュ

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Abstract

<p>A 69-year-old man with an unremarkable medical history presented with asymptomatic pancytopenia and diagnosed with Bence Jones protein-λ multiple myeloma (MM). Despite treatment with various chemotherapeutic regimens, myelosuppressive neutropenia occurred after each successive course; therefore, the treatment was determined to be ineffective and was discontinued. Consequently, one year after the diagnosis, a daratumumab-based therapy was initiated, and the MM was stabilized without clinical or laboratory evidences of myelosuppression. However, 18 months after the daratumumab induction, the patient developed hematochezia. Following an unremarkable lower gastrointestinal endoscopy, he presented fever and disturbed consciousness. Serum laboratory results showed liver dysfunction, and Listeria monocytogenes meningitis was diagnosed by cerebrospinal fluid examination. Empiric antibacterial treatment was administered for 3 weeks, which resolved the symptoms with no permanent neurological deficit.</p><p>Daratumumab, a CD38 monoclonal antibodies, binds to expressed CD38 on myeloma cells and has an anti-myeloma cytotoxic effect but also binds to CD38 on activated macrophages. Additionally, activated macrophages play an important role in the immune defense of Listeria monocytogenes. Furthermore, inactivation of macrophages may increase the susceptibility to Listeria infection. Therefore, the possibility of infections such as Listeria meningitis should be considered in patients with MM receiving daratumumab-based therapy.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 61 (11), 1611-1615, 2020

    The Japanese Society of Hematology

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