注射用培美曲塞二钠致丹毒1例

Pemetrexed-associated erysipelas in a patient with non-small cell lung carcinoma

关键词:  培美曲塞  不良反应  丹毒

Key words:  pemetrexed  erysipelas  non-small cell lung carcinoma  case report  adverse drug reaction

摘要:

背景：培美曲塞是一种多靶点叶酸拮抗剂，被批准用于非小细胞肺癌和其他恶性肿瘤，相关的短期不良事件有很好的描述。然而，关于培美曲塞的长期后遗症的信息并不充分。 病例报告：一名70岁的非小细胞肺癌患者在输注培美曲塞加贝伐单抗第22周期后出现丹毒发作。经静脉注射青霉素治疗后症状缓解。一个月后，患者再次使用培美曲塞加贝伐单抗后，同样的皮肤疹复发。此后，培美曲塞停药，患者继续接受单药贝伐单抗治疗，直至目前。随访8个月无复发。因此，我们排除贝伐单抗引起丹毒，认为本例丹毒是培美曲塞所致。通过应用Naranjo不良反应概率量表，该患者丹毒和培美曲塞之间的可能关系至少得到了数据(Naranjo评分8)的支持。 结论:尽管皮肤毒性是培美曲塞的一个众所周知的副作用，但培美曲塞引起丹毒以前从未被报道过。它属于培美曲塞的长期毒性。肿瘤学家和皮肤科医生应该注意这种皮肤不良反应。

Abstract:

BACKGROUND Pemetrexed was a multi-targeted folate antagonists approved for non-small cell lung cancer and other malignancies, and the associated short-term adverse events were very well described. However, there was insufficient information regarding the long-term sequelae of pemetrexed. CASE REPORT A 70-year-old patient with a non-small cell lung cancer developed an episode of erysipelas after infusion of the 22th cycle of pemetrexed plus bevacizumab. His symptoms were relieved after treatment with intravenous penicillin. One month later, the patient experienced a recurrence of the same skin eruption after re-introduction of pemetrexed plus bevacizumab. Since then, pemetrexed was stopped and the patient went on to receive single-agent bevacizumab until present. However, there was no recurrence during 8 months of follow-up. Therefore, we ruled out that bevacizumab caused erysipelas, and believed this case erysipelas was induced by pemetrexed. By applying the Naranjo ADR probability scales, at least a probable relationship between erysipelas and pemetrexed in this patient was supported by the data (Naranjo score 8). CONCLUSIONS Although skin toxicity was a well-known side effect of pemetrexed, pemetrexed causing erysipelas had never been previously described. It belonged to a long-term toxicity of pemetrexed. Oncologists and dermatologists should be aware of this adverse cutaneous reaction.