Should CD4 Levels be Monitored in a Patient on Temozolomide?
  • Sriram Gonakoti
    John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA
  • Luis Parra-Rodriguez
    John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA


Temozolomide, non-typhoidal salmonellae, septic arthritis


Introduction: Temozolomide is an alkylating agent, indicated in the treatment of refractory anaplastic astrocytoma and newly diagnosed glioblastoma. We describe a case of Salmonella typhimurium bacteraemia associated with septic arthritis in the setting of concurrent temozolomide use.

Case: A 67-year-old woman presented with acute onset of bilateral knee pain and swelling. She had a medical history of glioblastoma multiforme treated with temozolomide. Synovial fluid analysis and blood cultures revealed S. typhimurium, confirming a diagnosis of S. typhimurium bacteraemia associated with septic arthritis.

Conclusion: We conclude that chemotherapy with temozolomide and corticosteroid use will increase an individual’s susceptibility to a wide variety of opportunistic infections akin to HIV-associated acquired immunodeficiency syndrome (AIDS). Furthermore, we hypothesize a possible benefit of monitoring CD4 levels and prophylaxis against opportunistic infections (based on the CD4 levels) in individuals receiving temozolomide-based chemotherapy, similar to HIV-AIDS.



  • Su YB, Sohn S, Krown SE, Livingston PO, Wolchok JD, Quinn C, et al. Selective CD4+ lymphopenia in melanoma patients treated with temozolomide: a toxicity with therapeutic implications. J Clin Oncol 2004;22(4):610–616 [erratum in J Clin Oncol 2004;22(10):2038].
  • Stepanovic A, Nikitovic M. Severe hematologic temozolomide-related toxicity and life-threatening infections. J BUON 2018;23(1):7–13.
  • Kizilarslanoglu MC, Aksoy S, Yildirim NO, Ararat E, Sahin I, Altundag K. Temozolomide-related infections: review of the literature. J BUON 2011;16(3):547–550.
  • Georgescu G, Isola IM, Youssef S, Adachi J, Rolston K. Disseminated salmonellosis in a patient treated with temozolomide. J Infect 2008;57(5):414–415.
  • National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology. Prevention and treatment of cancer-related infections. Version 2.2020.
  • Views: 621
    HTML downloads: 64
    PDF downloads: 451

    Published: 2021-03-11
    Issue: 2021: Vol 8 No 3 (view)

    How to cite:
    Gonakoti S, Parra-Rodriguez L. Should CD4 Levels be Monitored in a Patient on Temozolomide?. EJCRIM 2021;8 doi:10.12890/2021_002276.