Fatal Pneumonia Associated with Temozolomide Therapy in Patients with Malignant Glioma
Fatal Pneumonia Associated with Temozolomide Therapy in Patients with Malignant Glioma
复制标题
恶性胶质瘤患者与替莫唑胺治疗相关的致命性肺炎
DOI：
10.1093/jjco/hys058
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发表时间：
2012
期刊：
影响因子：
2.4
通讯作者：
Gemma A
中科院分区：
文献类型：
--
作者：
Hayashi H;Saito Y;Kokuho N;Morimoto T;Kobayashi K;Tanaka T;Abe S;Fujita K;Azuma A;Gemma A
本报告介绍了三例致命性肺炎患者的病例，根据血清学诊断，高度怀疑为肺孢子菌肺炎（PCP）。他们的胸片显示双侧肺炎，到达医院时均出现严重呼吸衰竭，需要机械通气。尽管无法进行支气管镜取样，但他们的胸部计算机断层扫描成像和血清 KL-6 和 β-d-葡聚糖水平显着升高是肺孢子菌肺炎的特征。所有三人均被发现在恶性神经胶质瘤手术后接受了替莫唑胺治疗。替莫唑胺可引起肺孢子菌肺炎。这三名患者在替莫唑胺治疗期间没有接受预防肺孢子菌肺炎的药物，他们的病史表明他们都推迟了寻求治疗。肺孢子虫肺炎的诊断可能很困难，因为其症状并非肺孢子虫肺炎所特有的，而且往往与常见呼吸道传染病的症状相似。因此，接受替莫唑胺治疗的患者有可能发展为致命性肺炎，应仔细观察。还应充分告知患者有关肺孢子虫肺炎的信息，并在开始替莫唑胺治疗前积极考虑预防肺孢子虫肺炎。
This report presents the cases of three patients with fatal pneumonia that was highly suspected to bePneumocystispneumonia (PCP) based on serological diagnosis. Their chest radiographs showed bilateral pneumonia and each had presented with severe respiratory failure requiring mechanical ventilation when they arrived at the hospital. Although bronchoscopical sampling could not be performed, their chest computed tomography imaging and a marked elevation of serum KL-6 and β-d-glucan levels were characteristic ofPneumocystispneumonia. All three were found to have been treated with temozolomide after surgery for malignant glioma. Temozolomide can causePneumocystispneumonia. The three patients did not receive prophylactic medication againstPneumocystispneumonia during treatment with temozolomide, and their histories suggested that all had delayed seeking treatment. It may be difficult to diagnosePneumocystispneumonia because the symptoms are not specific forPneumocystispneumonia and they tend to be similar to those of common respiratory infectious diseases. Therefore, patients who receive temozolomide therapy have the potential to develop fatal pneumonia and should be carefully observed. The patients should also be adequately informed aboutPneumocystispneumonia, and prophylaxis againstPneumocystispneumonia should be considered proactively before treatment with temozolomide is initiated.