Temozolomide
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Temozolomide Tonsillar pseudotumour and lymphopenia: case report A 45-year-old woman developed lymphopenia and a tonsillar pseudotumour during treatment with temozolomide for glioblastoma. The woman was diagnosed with left occipitoparietal glioblastoma in 2007. Following resection, she received external beam radiation and temozolomide 75 mg/m2 [route and frequency not stated]. She then started receiving temozolomide 150 mg/m2 (7 days on followed by 7 days off, every 14 days). She completed 24, 1-month cycles. She developed lymphopenia in the second month of treatment. When she developed grade 4 lymphopenia, she started receiving dapsone for Pneumocystis carinii pneumonia prophylaxis; she later received cotrimoxazole [trimethoprim/ sulfamethoxazole]. After cycle 22, she developed frequent upper respiratory infections. A few weeks after her cycle 24 visit, she reported odynophagia and an upper respiratory tract infection. She had a productive cough and had lost 15lb in 6 weeks. Examinations revealed an extensive, ulcerated mass involving her right soft palate and right oropharynx including her tongue base; a squamous cell carcinoma was suspected. Pathological examination revealed ulcerated mucosa with granulation tissue and mixed inflammation, with no carcinoma or granulomas. Further testing revealed a herpes simplex virus infection, with scattered cells positive for cytomegalovirus and Epstein-Barr virus. The woman received antibiotics, antivirals and antifungals. After 6 weeks, her symptoms had almost resolved. CT scan showed a marked improvement with almost complete resolution of the lesions. At last follow-up, her mucosal surfaces were healthy. Her final diagnosis was of a multipleorganism infection precipitated by chemotherapy-induced immunosuppression. Grisdale K, et al. Tonsillar pseudotumor: Complications of chronicallyadministered temozolomide. Journal of Neuro-Oncology 100: 475-479, No. 3, Dec 2010. Available from: URL: http://dx.doi.org/10.1007/s11060-010-0207-8 803047187 USA
0114-9954/10/1334-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 15 Jan 2011 No. 1334
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