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Abdominal discomfort and thrombopenia: case report A male patient [age not stated] developed intermittent abdominal discomfort and thrombopenia during treatment with doxycycline and linezolid respectively for an intracranial mass and a pulmonary infection with M. fortuitum. The male patient presented to hospital with a 1-month history of abduction limitation and left eye ptosis. Six months before, he also had left hemicrania headache and a weight loss associated with asthenia. His medical history included a self-resolved hepatitis B infection and a schistosomiasis treated in 2016 and 2018. He also had a travel history to Tchad once in 2018. On presentation, he underwent several laboratory tests and examination and diagnosed with an intracranial mass and a pulmonary infection with M. fortuitum. The male patient received treatment with glucocorticosteroids and standard empirical antituberculous therapy included ethambutol, pyrazinamide, rifampicin [rifampicine] and isoniazid. Later, pyrazinamide and ethambutol were discontinued and amikacin, imipenem and ciprofloxacin were started. About 10 days later, with the identification of M. fortuitum by sequencing, treatment with only amikacin, imipenem and ciprofloxacin were continued. After 4 weeks of targeted therapy, he was discharged on oral moxifloxacin, linezolid and doxycycline [not all dosage stated]. On follow-up, his other symptoms were resolved, and he was only suffering from intermittent headaches. However, 1 week after introduction of linezolid, he developed a worsening thrombopenia, for which the dosage was reduced from 2×600 mg/day to 1×600 mg/day. He also developed intermittent abdominal discomfort due to the administration of doxycycline [duration of treatment to reaction onset not stated]. Later linezolid was discontinued after 10 weeks to avoid linezolid-induced neuropathy. However, 8 months later, MRI showed residual collection for which linezolid 600mg once a day was reintroduced. No further toxicity was noted. The treatment was stopped after a total of 13 months with a favourable clinical and radiological evolution. D’Incau S, et al. Mycobaterium fortuitum disseminated infection in an immunocompetent patient without predisposing factors. BMJ Case Reports 13: e235842, No. 9, 29 Sep 803517440 2020. Available from: URL: http://doi.org/10.1136/bcr-2020-235842

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Reactions 28 Nov 2020 No. 1832