Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma
Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma
复制标题
DOI：
10.1007/s00280-009-1167-6
复制
发表时间：
2010-02-01
影响因子：
3
通讯作者：
Capelozzi, Vera Luiza
中科院分区：
文献类型：
--
作者：
Ferreira Galvao, Flavio Henrique;Medina Pestana, Jose Osmar;Capelozzi, Vera Luiza
吉西他滨是一种化疗药物，可能会导致不可预测的副作用。在这个报告中，我们描述了一个致命的吉西他滨诱导的肺毒性患者的胆囊转移性腺癌。一个72岁的病人提交了选择性腹腔镜胆囊切除术，胆囊管状腺癌被偶然诊断。术前CT及超声未见肿瘤。手术后，Pet扫描显示左结肠有一个热点。结肠病变被方便地切除，组织学评估证实了小管腺癌的诊断。然后，患者接受三段剂量为1600 mg/m(2)的吉西他滨治疗，间隔时间为1周。三周后，他出现了严重的呼吸窘迫。螺旋CT扫描显示弥漫性和严重间质性肺炎，肺活检证实加速正常间质性肺炎与药物毒性一致。患者病情发展不利，呼吸功能渐进性恶化，低血压，肾功能衰竭。尽管接受了甲基强的松龙脉冲治疗、大范围抗菌药物治疗以及呼吸、血液动力学和肾脏系统的全力支持，他还是在1个月后死亡。吉西他滨引起的肺毒性通常是一种严重的情况。医生应该怀疑吉西他滨化疗后出现呼吸窘迫的患者（主要是老年患者）的肺毒性。
Gemcitabine is a chemotherapy agent that may cause unpredictable side effects. In this report, we describe a fatal gemcitabine-induced pulmonary toxicity in a patient with gallbladder metastatic adenocarcinoma. A 72-year-old patient was submitted to an elective laparoscopic cholecystectomy, and a tubular adenocarcinoma in the gallbladder was incidentally diagnosed. CT scan and ultrasound before the surgery did not show any tumor. After the surgery a Pet scan was positive for a hot-spot in the left colon. The colonic lesion was conveniently removed and the histology evaluation confirmed the diagnosis of adenocarcinoma tubular. The patient was then submitted to three sections of 1,600 mg/m(2) of gemcitabine with intervals of 1 week. Three weeks later he developed severe respiratory distress. A helicoidal CT scan showed diffuse and severe interstitial pneumonitis, and lung biopsy confirmed accelerated usual interstitial pneumonia consistent with drug-induced toxicity. The patient presented unfavorable evolution with progressive worsening of respiratory function, hypotension, and renal failure. He died 1 month later in spite of methylprednisolone pulse therapy, large spectrum antimicrobial therapy, and full support of respiratory, hemodynamic and renal systems. Gemcitabine-induced pulmonary toxicity is usually a dramatic condition. Physicians should suspect pulmonary toxicity in patients with respiratory distress after gemcitabine chemotherapy, mainly in elderly patients.