奥沙利铂甘露醇注射液致剥脱性皮炎

Exfoliative dermatitis related to oxaliplatin and mannitol injection

1例62岁女性胃癌患者在根治术后接受奥沙利铂甘露醇注射液(第1天)+替吉奥(第1~14天)治疗,21 d为1个周期。每次应用奥沙利铂甘露醇注射液前3 h予地塞米松等药物预处理以减轻化疗不良反应。第1周期化疗期间,患者除恶心、乏力外未出现其他不良反应,未予干预。第2周期奥沙利铂甘露醇注射液滴注结束后约2 h,患者四肢肿胀、潮红,皮肤出现红色斑片,之后红斑增多并融合成片,足部皮肤脱屑,经抗过敏治疗后上述症状好转。第3周期奥沙利铂甘露醇注射液滴注结束后约3 h,患者出现呼吸困难,全身皮肤潮红、肿胀,伴抓痕;之后,部分皮肤可见大水疱,关节屈曲处水疱裂开,有渗出液浸渍。给予甲泼尼龙等抗过敏治疗,4 d后患者全身皮肤呈鳞片状脱屑,手足皮肤呈手套状脱落,诊断为剥脱性皮炎;9 d后患者皮肤颜色变浅,无新发皮疹。考虑剥脱性皮炎由奥沙利铂甘露醇注射液所致,将化疗方案更改为多西他赛(第1天)+替吉奥(第1~14天),患者未再出现皮肤过敏反应。

A 62‑year‑old female patient with stomach cancer received an IV infusion of oxaliplatin and mannitol injection on day 1 and oral tegafur,gimeracil,and oteracil potassium on days 1‑14 in a 21‑day cycle after radical mastectomy.Pretreatment with dexamethasone and other drugs was given 3 hours before the infusion to alleviate possible adverse reactions.During the 1st cycle of chemotherapy,the patient had no other adverse reaction except nausea and fatigue,and no intervention was given.About 2 hours after oxaliplatin and mannitol injection in the 2nd cycle,the patient′s limbs were swollen and flushed,and red patches appeared on the skin.Then the erythema increased and merged into patches and her skin on the feet was desquamated.The above symptoms were improved after anti‑allergic treatments.About 3 hours after oxaliplatin and mannitol injection in the 3rd cycle,the patient developed dyspnea,and systemic skin flushing and swelling accompanied by scratches.Then visible blisters on part of the skin appeared,which cracked at the flexion of the joints with exudate impregnation.The patient was given anti‑allergic therapy such as prednisolone.Four days later,her skin on the whole body showed scaly desquamation,her hands and feet showed gloved desquamation,and she was diagnosed as having exfoliative dermatitis;9 days later,her skin color became lighter and there was no new rash.Considering that exfoliative dermatitis was caused by oxaliplatin and mannitol injection,the chemotherapy regimen was switched to docetaxel(day 1)and tegafur,gimeracil,and oteracil potassium(days 1‑14).The skin allergic reactions did not recur.