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Embryonal rhabdomyosarcoma: case report An 8-year-old girl developed embryonal rhabdomyosarcoma during treatment with prednisolone, ciclosporin and mycophenolic acid for nephrotic syndrome [routes not stated]. The girl was diagnosed with nephrotic syndrome at the age of 2 years and 4 months. About 1 month later, she was referred to hospital due to relapse. She thus received prednisolone 45mg daily (2 mg/kg/day) for 4 weeks. Proteinuria resolved on prednisolone treatment. However, proteinuria recurred when prednisolone was taper from 45 mg/day to 25 mg/day and finally to 10 mg/day. Therefore, she again started receiving 45 mg/day. Nearly 3 months after the first relapse, she experienced a second relapse when the daily dose of prednisolone was decreased from 45mg daily to 30mg daily. Proteinuria resolved with prednisolone at 45 mg/day for nearly a week. Three months after the second relapse, a third relapse occurred when she had taken 30mg prednisolone once every 2 days for 3 weeks. Subsequently, ciclosporin [CsA] was added at a daily dose of 50 mg/day (1.7 mg/kg/day) on 19 September 2012. Over 3 months, prednisolone was tapered from 45 mg/dat to 5mg every two days. Ciclosporin was prescribed continuously, with the dose of 50mg daily. After about 1 years of regular use, prednisolone was discontinued on 19 August 2013. After a year of ciclosporin maintenance without steroid, she developed bilateral leg oedema, decreased urine output and massive proteinuria. The ciclosporin dose was increased to 75 mg daily (3 mg/kg/day) for 4 months and prednisolone was again started. The proteinuria resolved within 2 weeks under the combination of prednisolone 45mg daily and ciclosporin 75mg daily, tapered to 50mg daily for another 3 months. Later, again prednisolone was tapered from 45 mg/day to 5mg every two days for 2 months and finally stopped. Nine months from the previous relapse, she experienced fifth relapse, after she had been on prednisolone free for nearly 20 days. Since the fifth replace, the prednisolone was started at dose 60mg daily and ciclosporin was prescribed with dose 100mg daily. The sixth relapse had occurred since daily dose of steroid was discontinued, and the proteinuria was controlled under prednisolone 45mg daily. During the four-year use of steroids with other steroid-sparing immunosuppressive therapy, she experienced frequent urinary tract infections. On 4 March 2016, ciclosporin therapy was replaced with mycophenolic acid [myfortic acid] 720mg daily (20 mg/kg). At about 4 years after the diagnosis of nephrotic syndrome, she developed reddish flat-topped masses on her tongue. She underwent curative wedge resection, which revealed an exophytic polypoid lesion. Based on histopathological findings, she was diagnosed with embryonal rhabdomyosarcoma on 20 December 2016 [time to reaction onset not stated]. The girl therefore underwent total excision of the tumour, and she was treated with vincristine, actinomycin and cyclophosphamide (TPOG-RMS-LR protocol). Subsequently, mycophenolic acid and prednisolone