{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:33:04Z","timestamp":1769729584957,"version":"3.49.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,7,8]]},"abstract":"\n BACKGROUND<\/jats:title>\n Hypofractionated radiotherapy with temozolomide is recommended for older patients with glioblastoma. Nevertheless, a potential complication of treatment is opportunistic infections with immunosuppression.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n An 86-year-old man presented with hemiparesis, prompting an investigation that revealed a right frontotemporal glioblastoma, isocitrate dehydrogenase wildtype. After the diagnostic biopsy, hypofractionated radiotherapy with temozolomide was administered. Lymphocytopenia was observed before the start of chemoradiotherapy and gradually worsened until 2 months later, possibly as a side effect of the treatment. One month after the completion of the initial treatment, the patient developed septic shock, leading to death within 2 days. Postmortem examination with autopsy revealed evidence of an invasive\n Candida<\/jats:italic>\n infection possibly originating from the urinary catheter.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n \n Immunodeficiency, which is a side effect of radiation therapy with temozolomide, can cause rare and potentially fatal invasive\n Candida<\/jats:italic>\n infections, especially in older and frail patients with newly diagnosed glioblastoma, even with short-term hypofractionated chemoradiotherapy.\n <\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24175<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24175","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T02:50:00Z","timestamp":1720407000000},"source":"Crossref","is-referenced-by-count":0,"title":["Systemic Candida abscess after hypofractionated radiotherapy with temozolomide for glioblastoma in an older patient: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Kosuke","family":"Nambu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasunori","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sho","family":"Tamai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riho","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsutoshi","family":"Nakada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"Neuro Oncol","first-page":"iv1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013-2017","volume":"22","author":"Ostrom","year":"2020","unstructured":"Ostrom QTPatil NCioffi GWaite KKruchko CBarnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013-2017. Neuro Oncol. 2020;22(12suppl 2):iv1-iv96."},{"issue":"23","key":"bib2","series-title":"JAMA","first-page":"2306","article-title":"Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial","volume":"318","author":"Stupp","year":"2017","unstructured":"Stupp RTaillibert SKanner A, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma: a randomized clinical trial. 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Infect Dis Now. 2021;51(7):630-632."},{"issue":"3","key":"bib5","series-title":"Crit Rev Oncol Hematol","first-page":"373","article-title":"Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas","volume":"85","author":"De Vos","year":"2013","unstructured":"De Vos FYGijtenbeek JMBleeker-Rovers CPvan Herpen CM. Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas. Crit Rev Oncol Hematol. 2013;85(3):373-382."},{"issue":"16","key":"bib6","series-title":"Clin Cancer Res","first-page":"5473","article-title":"Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide","volume":"17","author":"Grossman","year":"2011","unstructured":"Grossman SAYe XLesser G, et al. Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide. Clin Cancer Res. 2011;17(16):5473-5480."},{"issue":"2","key":"bib7","series-title":"Case Rep Oncol","first-page":"410","article-title":"Aspergillosis in a patient receiving temozolomide for the treatment of glioblastoma","volume":"6","author":"Munhoz","year":"2013","unstructured":"Munhoz RRPereira Picarelli AATroques Mitteldorf CAFeher O. Aspergillosis in a patient receiving temozolomide for the treatment of glioblastoma. Case Rep Oncol. 2013;6(2):410-415."},{"issue":"20","key":"bib8","series-title":"Intern Med","first-page":"2967","article-title":"Management of cytomegalovirus infection in a patient with malignant glioma treated with temozolomide and steroids","volume":"51","author":"Okita","year":"2012","unstructured":"Okita YNarita YMiyakita YOhno MNagai SShibui S. Management of cytomegalovirus infection in a patient with malignant glioma treated with temozolomide and steroids. 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N Engl J Med. 2005;352(10):987-996."},{"issue":"1","key":"bib11","series-title":"Neurooncol Adv","first-page":"vdab153","article-title":"Impact of lymphopenia on survival for elderly patients with glioblastoma: a secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial","volume":"3","author":"Song","year":"2021","unstructured":"Song AJDing KAlnahhas I, et al. Impact of lymphopenia on survival for elderly patients with glioblastoma: a secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial. Neurooncol Adv. 2021;3(1):vdab153."},{"issue":"5","key":"bib12","series-title":"J Clin Oncol","first-page":"1375","article-title":"Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide","volume":"20","author":"Stupp","year":"2002","unstructured":"Stupp RDietrich PYOstermann Kraljevic S, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol. 2002;20(5):1375-1382."},{"key":"bib13","series-title":"J Clin Neurosci","first-page":"18","article-title":"Long-term glioblastoma survival following recovery from cytomegalovirus colitis: a case report","volume":"64","author":"Lamano","year":"2019","unstructured":"Lamano JBQuaggin-Smith JAHorbinski CM, et al. Long-term glioblastoma survival following recovery from cytomegalovirus colitis: a case report. J Clin Neurosci. 2019;64:18-21."},{"issue":"52 s","key":"bib14","series-title":"Clin Infect Dis","first-page":"S437","article-title":"Candida urinary tract infection: pathogenesis","author":"Fisher","year":"2011","unstructured":"Fisher JFKavanagh KSobel JDKauffman CANewman CA. Candida urinary tract infection: pathogenesis. 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Dexamethasone\u2014friend or foe for patients with glioblastoma?JAMA Neurol. 2019;76(3):247-248."},{"issue":"35","key":"bib17","series-title":"J Clin Oncol","first-page":"4145","article-title":"International Atomic Energy Agency randomized phase III study of radiation therapy in elderly and\/or frail patients with newly diagnosed glioblastoma multiforme","volume":"33","author":"Roa","year":"2015","unstructured":"Roa WKepka LKumar N, et al. International Atomic Energy Agency randomized phase III study of radiation therapy in elderly and\/or frail patients with newly diagnosed glioblastoma multiforme. J Clin Oncol. 2015;33(35):4145-4150."},{"issue":"1","key":"bib18","series-title":"BMC Cancer","first-page":"1105","article-title":"A randomized phase III study of short-course radiotherapy combined with temozolomide in elderly patients with newly diagnosed glioblastoma; Japan clinical oncology group study JCOG1910 (AgedGlio-PIII)","volume":"21","author":"Arakawa","year":"2021","unstructured":"Arakawa YSasaki KMineharu Y, et al. A randomized phase III study of short-course radiotherapy combined with temozolomide in elderly patients with newly diagnosed glioblastoma; Japan clinical oncology group study JCOG1910 (AgedGlio-PIII). 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Temozolomide is a risk factor for invasive pulmonary aspergillosis: a case report and literature review. Infect Dis Now. 2021;51(7):630-632."},{"issue":"3","key":"bib5","series-title":"Crit Rev Oncol Hematol","first-page":"373","article-title":"Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas","volume":"85","author":"De Vos","year":"2013","unstructured":"De Vos FYGijtenbeek JMBleeker-Rovers CPvan Herpen CM. Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas. Crit Rev Oncol Hematol. 2013;85(3):373-382."},{"issue":"16","key":"bib6","series-title":"Clin Cancer Res","first-page":"5473","article-title":"Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide","volume":"17","author":"Grossman","year":"2011","unstructured":"Grossman SAYe XLesser G, et al. Immunosuppression in patients with high-grade gliomas treated with radiation and temozolomide. Clin Cancer Res. 2011;17(16):5473-5480."},{"issue":"2","key":"bib7","series-title":"Case Rep Oncol","first-page":"410","article-title":"Aspergillosis in a patient receiving temozolomide for the treatment of glioblastoma","volume":"6","author":"Munhoz","year":"2013","unstructured":"Munhoz RRPereira Picarelli AATroques Mitteldorf CAFeher O. Aspergillosis in a patient receiving temozolomide for the treatment of glioblastoma. Case Rep Oncol. 2013;6(2):410-415."},{"issue":"20","key":"bib8","series-title":"Intern Med","first-page":"2967","article-title":"Management of cytomegalovirus infection in a patient with malignant glioma treated with temozolomide and steroids","volume":"51","author":"Okita","year":"2012","unstructured":"Okita YNarita YMiyakita YOhno MNagai SShibui S. Management of cytomegalovirus infection in a patient with malignant glioma treated with temozolomide and steroids. 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N Engl J Med. 2005;352(10):987-996."},{"issue":"1","key":"bib11","series-title":"Neurooncol Adv","first-page":"vdab153","article-title":"Impact of lymphopenia on survival for elderly patients with glioblastoma: a secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial","volume":"3","author":"Song","year":"2021","unstructured":"Song AJDing KAlnahhas I, et al. Impact of lymphopenia on survival for elderly patients with glioblastoma: a secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial. Neurooncol Adv. 2021;3(1):vdab153."},{"issue":"5","key":"bib12","series-title":"J Clin Oncol","first-page":"1375","article-title":"Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide","volume":"20","author":"Stupp","year":"2002","unstructured":"Stupp RDietrich PYOstermann Kraljevic S, et al. 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