Gähler A, Hitz F, Hess U, Cerny T
Abteilung Onkologie und Hämatologie, Kantonsspital St. Gallen, Switzerland.
Onkologie. 2003 Aug;26(4):348-50. doi: 10.1159/000072094.
Pericarditis is a rare but possibly severe complication of treatment of acute leukemia with cytarabine.
We report a possibly cytarabine-induced acute pericarditis and pleuritis with a rapid onset. A patient with acute myelomonocytic leukemia developed an isolated pericarditis 3 weeks after the first course of chemotherapy with cytarabine and idarubicin. The second course of chemotherapy with cytarabine and amsacrine was started after clinical improvement; 3 days later an acute pericarditis with a large pericardial effusion accompanied by a left pleural effusion developed. A pericardio- and pleuracentesis was performed and the symptoms improved rapidly without reaccumulation of the fluid. The third course of chemotherapy with mitoxantrone and etoposide was completed without further cardiopulmonary complications.
The differential diagnosis of pericarditis in the setting of chemotherapy with cytarabine should include cytarabine- induced pericarditis. The pathogenesis remains unclear, directly toxic and immunological mechanisms are suggested. Severe progression with massive pericardial effusion necessitating risky pericardiocentesis can occur and therefore a therapy with high-dose corticosteroids should be considered early.
心包炎是阿糖胞苷治疗急性白血病时一种罕见但可能严重的并发症。
我们报告一例可能由阿糖胞苷引起的急性心包炎和胸膜炎，起病迅速。一名急性粒单核细胞白血病患者在接受阿糖胞苷和伊达比星的首个化疗疗程3周后出现孤立性心包炎。在临床症状改善后开始第二个阿糖胞苷和安吖啶化疗疗程；3天后，出现急性心包炎伴大量心包积液及左侧胸腔积液。进行了心包穿刺和胸腔穿刺，症状迅速改善，积液未再积聚。第三个米托蒽醌和依托泊苷化疗疗程顺利完成，未出现进一步的心肺并发症。
在使用阿糖胞苷化疗的情况下，心包炎的鉴别诊断应包括阿糖胞苷诱导的心包炎。发病机制尚不清楚，提示有直接毒性和免疫机制。可能会出现严重进展并伴有大量心包积液，需要进行有风险的心包穿刺，因此应尽早考虑使用大剂量皮质类固醇进行治疗。
