氟尿嘧啶致结肠炎及手足综合征

Fluorouracil-induced colitis and hand-foot syndrome

1例48岁女性患者因腹痛在当地医院以“急性胰腺炎”给予5-氟尿嘧啶（1.0 g）、泮托拉唑（120 mg）和复方氨基酸注射液（18AA）（250 ml）静脉滴注，均1次／d。治疗第11天出现黏液血便伴里急后重、发热伴脱发及手足皮肤剥脱样改变，考虑“溃疡性结肠炎”，停用上述3种药物给予激素治疗。治疗近3个月，血便减少但腹痛加重，脱发及手足皮肤损害无改善，遂转入西京医院。结肠黏膜活体组织病理检查未见明显隐窝结构改变，结合患者病史及毛发、手足皮肤改变，考虑为药物诱导性结肠炎及手足综合征。激素逐渐减量至停用，给予丙胺酰谷氨酰胺修复肠道黏膜、调节肠道菌群，甲硝唑抗感染，并给予肠道营养支持治疗，5d后患者腹痛、黏液血便停止，毛发脱失改善，手足皮肤损害逐渐恢复。随访4个月，未再出现腹痛、血便，毛发及手足皮肤恢复正常。

A 48-year-old female patient with abdominal pain was diagnosed as＆quot;acute pancreatitis＆quot;at the local hospital and received IV infusion of fluorouracil 1. 0 g,pantoprazole sodium 120 mg and amino acid（18AA）250 ml once daily. On day 11 of treatments,she developed mucous bloody stool with tenesmus,fever with alopecia, and exfoliative changes of her hand-foot skin. Ulcerative colitis was considered. Drugs above mentioned were stopped and glucocorticoid treatment was given. After 3 months of hormone treatment,her mucous bloody stool relieved,the abdominal pain exacerbated,and alopecia and hand-foot damages was not improved. Then,she came to Xijing Hospital. Pathological examination of living tissue in colonic mucosa showed no crypt structure changes. According to the patient＇s history,changes of hair and hand-foot skin,and her pathological examination results,the drug-induced colitis and hand-foot syndrome was considered. The dosage of glucocorticoid was gradually reduced and stopped at last. Propylamine acyl glutamine was given to repair the intestinal mucosa and keep the balance of the gut bacteria and intestinal nutrition,metronidazole for anti-infection,and enteral nutrition for supportive treatments. After 5 days of treatments,the patient＇s symptoms of abdominal pain and mucous bloody stool relieved,hair loss and skin damage recovered gradually. At 4 months of follow up,abdominal pain and bloody stool did not recur and her hair and skin returned to normal.