地舒单抗导致反弹性高钙危象一例报告

Rebound hypercalcemia crisis during withdrawal of denosumab:a case report

报道1例13岁动脉瘤样骨囊肿男性患儿,在30个月时间内共使用了14次120 mg地舒单抗,累计剂量为1680 mg,平均剂量42 mg/kg。治疗过程中患者症状和病灶情况均得到了明显改善;但随着累积剂量的增加和用药时间的延长,患者先出现低钙血症,随后出现严重的反弹性高钙血症,经过住院对症治疗,患者血钙在3 d内恢复正常水平,高血钙症状缓解。该病例提示长期大量使用地舒单抗停药后有反弹性高钙血症的潜在风险,青少年相较于成年人更易发生,在初始治疗时就应该慎重选药,并且在用药期间注意定期监测血钙,必要时考虑序贯治疗。

We report a 13-year-old boy with aneurysmal bone cyst,who received 14 doses of subcutaneous 120 mg denosumab(the cumulative dose was 1680 mg,the average dose was 42 mg/kg)over a 30-month period.After treatment,his symptoms and lesions significantly improved.However,with the increase of cumulative dose and the extension of medication time,he developed hypocalcemia followed by severe rebound hypercalcemia.After symptomatic treatment,the patient's blood calcium returned to normal within 3 days,and the symptoms of hypercalcemia were relieved.This case indicates the potential risk of rebound hypercalcemia after long-term and large-scale use of denosumab,which is more likely to occur in adolescents than in adults.Drugs should be carefully selected during initial treatment,and blood calcium should be monitored regularly during denosumab treatment.Sequential treatment should be considered if necessary.