培美曲塞引起剥脱性皮炎、腹泻和骨髓抑制致死亡

Death due to exfoliative dermatitis,diarrhea,and myelosuppression caused by pemetrexed

1例74岁男性患者因肺腺癌在原有厄洛替尼治疗的基础上加用培美曲塞化疗。首次给予培美曲塞800 mg溶于0.9%氯化钠注射液100 ml中静脉滴注。用药后第3天患者出现全身皮疹,并逐渐出现口腔黏膜溃疡、肛周及阴囊部皮肤破溃,诊断为剥脱性皮炎。用药后第6天患者出现腹泻,并逐渐加重,从3~4次/d至10~12次/d。用药后第9天出现Ⅳ度骨髓抑制,白细胞计数(WBC)0.6×10^9/L,中性粒细胞计数0.1×10^9/L,红细胞计数(RBC)2.04×10^12/L,血红蛋白(Hb)65 g/L,血小板计数(PLT)77×109/L。尽管给予积极抗过敏、止泻、刺激血细胞再生药物治疗,患者骨髓抑制进行性加重。用药后第15天,WBC 0.1×10^9/L,中性粒细胞计数0,RBC 2.53×10^12/L,Hb 80 g/L,PLT 1×10^9/L。患者家属放弃治疗,用药后第18天患者死亡。

A 74-year-old male patient was treated with pemetrexed on the basis of erlotinib for lung adenocarcinoma.For the first time,pemetrexed 800 mg dissolved in 0.9%sodium chloride 100 ml was given by intravenous injection.On the 3rd day after the treatment,the patient developed generalized skin rash,and then ulceration of oral mucosa and skin ulceration of perianal and scrotal area gradually appeared.The patient was diagnosed with exfoliative dermatitis.On the 6th day after the treatment,the patient developed diarrhea,which was gradually aggravated with the increased frequency from 3 to 4 times to 10 to 12 times daily.On the 9th day,after the treatment the patient developed myelosuppression(grade IV),with white blood cell count(WBC)0.6×10^9/L,neutrophils count 0.1×10^9/L,red blood cell count(RBC)2.04×10^12/L,hemoglobin(Hb)65 g/L,and platelet count(PLT)77×10^9/L.Despite the active treatments with anti-allergy,antidiarrheal,and blood cell regeneration stimulating drugs,the patient′s myelosuppression was aggravated.On the 15th day after the treatment,laboratory tests showed WBC 0.1×10^9/L,neutrophil count 0,RBC 2.53×10^12/L,Hb 80 g/L,and PLT 1×10^9/L.The patient′s treatment was given up at the request of his family members and the patient died on the 18th day after the treatment.