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Drug-induced immune thrombocytopenia: case report A 73-year-old man developed drug-induced immune thrombocytopenia (DITP) during treatment with dexamethasone as an antiemetic prophylaxis and bevacizumab and oxaliplatin for rectal cancer [not all dosages stated]. The man, who had rectal cancer (cT2N0M0; Stage I), underwent laparoscopic-assisted abdominal-perineal transrectal amputation and D3 lymph node dissection plus sigmoid colostomy in April 20XX [sic]. Postoperatively, he was diagnosed with moderately differentiated adenocarcinoma (pT2N1cM0; stage IIIA). Adjuvant chemotherapy with tegafur/uracil plus and oral folinic acid [leucovorin] treatment was continued for half a year as after June 20XX. In October 20XX+1, a CT scan revealed multiple lung metastases and a relapse of rectal cancer. In January 20XX+2, he was initiated on IV oxaliplatin 85 mg/m2(administered for 120 min), fluorouracil [5-fluorouracil], IV folinic acid [leucovorin] 200 mg/m2 (administered for 120 min), and IV bevacizumab 5 mg/kg (administered for 90 min) combination therapy repeated every 2 weeks (mFOLFOX6 + Bev regimen) as first-line chemotherapy. Additionally, he received a continuous intravenous injection of fluorouracil and IV dexamethasone injection 6.6mg [Dexart]. Concomitantly, he received sodium chloride [saline], palonosetron and levofolinic acid [L-levofolinate]. Thereafter, the lung metastases shrank and he achieved a partial response (PR) after 10 cycles. In June 20XX+3, mild allergic symptoms including rash and forehead discomfort appeared during the co-administration of oxaliplatin and folinic acid, at 32nd course of oxaliplatin, fluorouracil, folinic acid and bevacizumab regimen. Initially, oxaliplatin was suspected as the cause, but allergic symptoms appeared despite omitting oxaliplatin administration. It was decided to sequentially omit any suspicious drugs. Finally, folinic acid was considered to be the cause of allergic reaction. Subsequently, the regimen was switched to oral gimeracil/oteracil/tegafur [S-1], IV oxaliplatin 130 mg/m2 (administered for 120 min) and IV bevacizumab 7.5 mg/kg (administered for 90 min) combination therapy (SOX+BV regimen) repeated every 3 weeks, which did not contained folinic acid. Additionally, he received dexamethasone injection 6.6mg [Dexart]. On admission in September, gimeracil/oteracil/tegafur, oxaliplatin and bevacizumab combination therapy was administered and no allergic reactions were seen. However, on day 2 of treatment, thrombocytopenia was observed. The WBC, RBC and coagulation parameters were normal. Thrombocytopenia as a marker of bone marrow suppression resulting from chemotherapy, pseudo-thrombocytopenia, heparin-induced thrombocytopenia and idiopathic thrombocytopenic purpura were excluded. Thrombocytopenia was finally confirmed by a blood test using a heparin blood collection tube. The discontinuation of suspected drugs immediately restored platelet counts although the platelet-associated-IgG level was elevated. Based on these situations and the diagnostic criteria, DIT