Cisplatin
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Cervical osteomyelitis secondary to decreased vascularisation: case report In a case report of 2 patients, a 57-year-old man was described, who developed cervical osteomyelitis secondary to decreased vascularisation during treatment with cisplatin for oropharyngeal carcinoma. The man was diagnosed with T4 N0 M0 oropharyngeal carcinoma. He received chemoradiotherapy, comprising 3 courses of cisplatin 100 mg/m2 [route not stated], along with radiotherapy (35 x 2 Gy). During the chemoradiotherapy, a persisting ulcer of the posterior pharyngeal wall was noted (part of the carcinoma), which was successfully treated with hyperbaric oxygen therapy. In January 2010, a relapse of a T1 N0 second primary squamous cell carcinoma of the posterior and lateral pharyngeal wall, extending into the nasal side of the palate was observed. He underwent CO2 laser excision. After 2 months of the excision, he developed sever neck pain extending to the shoulders and fever. His blood examinations revealed elevated CRP to 216 mg/L. An MRI of the cervical spine revealed massive osteolysis of C1 and C2 along with surrounding soft tissue mass. A CT-guided biopsy revealed inflammatory changes. Other investigations were unremarkable. Based on the clinical presentation and results of the investigations, cervical osteomyelitis was suspected [time to reaction onset not stated]. The man was treated with ceftazidime for 2 weeks and clindamycin phosphate for 3 months. He further developed cervical spine instability, which was considered to be due to cervical osteomyelitis. He required application of the haloframe for 3.5 months, for the cervical spine instability. After 3 months of the antibiotic treatment, he was free from all the symptoms. An MRI after 6 months revealed regression of the mass at C1–C2. Subsequently, it was concluded that the chemoradiotherapy induced decrease vascularisation of the area, that further lead to cervical osteomyelitis and the cervical spine instability. Jacqueline Timmermans A, et al. Cervical osteomyelitis after carbon dioxide laser excision of recurrent carcinoma of the posterior pharyngeal wall. Annals of Otology, 803504958 Rhinology and Laryngology 122: 273-276, No. 4, Apr 2013. Available from: URL: http://doi.org/10.1177/000348941312200410
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Reactions 3 Oct 2020 No. 1824
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