A case of progressive digital ischemia after early withdrawal of gemcitabine and S-1 in a patient with systemic sclerosis
A case of progressive digital ischemia after early withdrawal of gemcitabine and S-1 in a patient with systemic sclerosis
复制标题
系统性硬化症患者早期停用吉西他滨和S-1后出现进行性手指缺血一例
DOI：
10.1093/jjco/hyr045
复制
发表时间：
2011
期刊：
影响因子：
2.4
通讯作者：
Mimori T
中科院分区：
文献类型：
--
作者：
Zaima C;Kanai M;Ishikawa S;Kawaguchi Y;Masui T;Mori Y;Nishimura T;Matsumoto S;Yanagihara K;Chiba T;Mimori T
系统性硬化症患者化疗的安全性尚不清楚，几乎没有发表的报告记录了这种情况下化疗的副作用。在此，我们报告一例系统性硬化症患者，他在联合吉西他滨/S-1治疗胰腺癌的过程中出现严重的指端缺血。尽管进行了积极的治疗，但手指和脚趾的缺血逐渐恶化，并出现坏疽改变。在这例患者中，系统性硬化症得到了很好的控制，在过去的6年中没有出现手指缺血症状，所以尽管进行了积极的治疗，但这种进行性的临床病程强烈地表明化疗引发或加重了手指的坏死。据我们所知，这只是第三例报告的系统性硬化症患者在基于吉西他滨的化疗后发展为数字坏死。系统性硬化症患者化疗期间数字坏死的发生率尚不清楚，其发生机制也不清楚，但迄今发表的三份报告，包括本病例，建议医生在对系统性硬化症患者进行基于吉西他滨的化疗时应非常谨慎。任何由此产生的指端缺血可能难以治疗并逐渐恶化，即使在指端缺血的早期阶段停止化疗也是如此。
The safety of chemotherapy for patients with systemic sclerosis is unclear, and there are few published reports documenting the side effects of chemotherapy in patients with this condition. Here, we report the case of a patient with systemic sclerosis who developed severe digital ischemia during combination gemcitabine/S-1 chemotherapy for pancreatic cancer. In spite of aggressive treatment, the digital ischemia progressively worsened and gangrenous changes developed in multiple fingers and toes. In this patient, the systemic sclerosis had been well controlled, with no digital ischemic symptoms for the previous 6 years, so this progressive clinical course in spite of aggressive treatment strongly suggests that the chemotherapy triggered or aggravated the digital necrosis. To the best of our knowledge, this is only the third reported case of a patient with systemic sclerosis developing digital necrosis after gemcitabine-based chemotherapy. The incidence of digital necrosis during chemotherapy in patients with systemic sclerosis is unknown, and the mechanism by which it occurs is unclear, but the three reports published to date, including the present case, suggest that physicians should be very cautious about administering gemcitabine-based chemotherapy to patients with systemic sclerosis. Any resulting digital ischemia might be refractory to treatment and worsen progressively, even if chemotherapy is withdrawn in the early stages of digital ischemia.