Shibata S, Kami M, Kanda Y, Machida U, Iwata H, Kishi Y, Takeshita A, Miyakoshi S, Ueyama J, Morinaga S, Mutou Y
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Am J Hematol. 2001 Apr;66(4):303-5. doi: 10.1002/ajh.1063.
A 63-year-old man received high-dose cyclophosphamide for peripheral blood stem-cell (PBSC) harvest. He received 200 mg fluconazole. On day 3, atrial fibrillation developed with blood pressure declining to 78 mmHg. The rapid adrenocorticotropin (ACTH) test showed blunted adrenal responses. He was suspected as having adrenal failure, and fluconazole was discontinued. The rapid ACTH test became normal on Day 14, and PBSCs were successfully harvested. To clarify the association between adrenal failure and fluconazole, we resumed 400 mg fluconazole on Day 16 and repeated the test on Day 21, which showed blunted adrenal responses. This case demonstrates that prophylactic use of fluconazole can cause adrenal insufficiency.
一名63岁男性接受大剂量环磷酰胺以采集外周血干细胞（PBSC）。他服用了200毫克氟康唑。第3天，出现心房颤动，血压降至78 mmHg。快速促肾上腺皮质激素（ACTH）试验显示肾上腺反应迟钝。他被怀疑患有肾上腺功能不全，遂停用氟康唑。第14天快速ACTH试验恢复正常，外周血干细胞成功采集。为明确肾上腺功能不全与氟康唑之间的关联，我们在第16天重新给予400毫克氟康唑，并于第21天重复该试验，结果显示肾上腺反应迟钝。该病例表明预防性使用氟康唑可导致肾上腺功能不全。
