坏死性筋膜炎是多西他赛罕见的副作用

亚太糖尿病与肿瘤会议联合活动

2019年12月04-05日|日本东京

Jeffry Beta Tenggara

西罗亚医院，印度尼西亚

主题:RRJMHS

摘要

作品简介:多西紫杉醇经常用于治疗实体肿瘤，主要是通过破坏微管功能来抑制细胞分裂来治疗乳腺癌。虽然已知该药物可引起肌痛、关节痛和神经病变，但自2005年以来，关于该药物引起肌炎并发症的报道很少。我们提出了一个病例报告坏死性筋膜炎作为一个持续的肌炎条件发生后，多西他赛治疗。

病例报告:44岁女性，诊断为iiib期导管浸润性乳腺癌(ER/PR+ HER-)。手术治疗后，她接受了多西他赛和阿霉素的化疗。第6个化疗周期后，患者双膝疼痛，尤以左侧疼痛为主。症状持续发展，直至出现皮肤水泡和溃疡。体格检查生命体征正常，左大腿后部溃疡伴少量脓性分泌物，触诊僵硬压痛。实验室结果显示CRP和ESR升高，无WBC升高和差异计数移位。多普勒超声示软组织水肿，未见深静脉血栓征象，MRI造影示大腿肌增厚水肿，短内收肌、半腱肌、臀大肌、股外侧肌增强，符合坏死性肌炎。PET- CT示皮下组织不规则坏死，包括大腿后腔肌肉，左侧占位。结果与以往多西紫杉醇给药前的PET- CT研究不同。怀疑为肌炎并发继发感染，计划行手术清创。 At intraoperative procedure, the surgeon found necrotic muscular tissue with no sign of primary infection. The tissues were sent for pathology examination. Pathology examination revealed necrotic tissues with gas inclusion, inflammatory cells (PMN and lymphocyte) and necrotic vascular tissues, these findings consistent with necrotizing fasciitis. In 1990s, reports of Docetaxel side effect began to revealed myopathy condition with unexplained pathophysiology. Documented cases of acute inflammatory myositis in patients treated with Docetaxel began to publish since 2005. Until 2015 there are less than 10 cases reported the myositis side effect of Docetaxel. The proposed theory linking this effect were direct myotoxicity, systemic leakage of protein in the interstitial space, increased cytokine levels (primarily IL-6, IL- 8, IL-10), indirect muscle damage through hypocalcaemia and hyperthermia and accumulation of acid phosphatase in muscle lysosome. Although Docetaxel induced myositis was an exclusion diagnosis, this rare side effect must be considered to prevent further deteriorating condition.

讨论:肌炎和坏死性筋膜炎是多西他赛罕见的副作用，自2005年以来仅有少数报道。有几种被提出的机制与这种情况有关。为防止病情进一步恶化，必须考虑并及早认识到这一情况。

传记

Jeffry Beta Tenggara在治疗肿瘤患者方面有8年的经验。他目前在雅加达西罗亚癌症医院(MRCCC Siloam Hospital Jakarta)工作，担任内科肿瘤学家和成员。除了他的医疗实践之外，他还是印度尼西亚内科学会、印度尼西亚肿瘤学会和印度尼西亚医学协会的成员。

电子邮件:(电子邮件保护)

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