Yokote Taiji, Akioka Toshikazu, Nakayama Shoko, Oka Satoko, Hara Satoshi, Yamano Takeshi, Tsuji Motomu, Hanafusa Toshiaki
First Department of Internal Medicine, Osaka Medical College.
Rinsho Ketsueki. 2005 Sep;46(9):1060-4.
A 35-year-old woman attended our hospital with chronic myeloid leukemia and was prescribed imatinib mesylate. She was admitted with lower abdominal pain, stomatitis, and hyposthenia after an increase in her dose of imatinib mesylate. When the treatment was changed to interferon-alpha and Ara-C, the lower abdominal pain, stomatitis, and hyposthenia improved, but bone marrow aspiration showed 36.4% blasts. After the treatment was changed back to an increased dose of imatinib mesylate (800 mg), the stomatitis deteriorated and intestinal bleeding reoccurred. Endoscopy demonstrated the presence of multiple ulcers in the ascending colon and 99mTc RBC scintigraphy demonstrated lesions of the large and small intestine. The patient declined any treatment except for transfusion and died suddenly after ten days. The present case suggests that we should carefully consider the possibility of intestinal bleeding when prescribing imatinib mesylate.
一名35岁女性因慢性髓性白血病前来我院就诊，服用甲磺酸伊马替尼。在增加甲磺酸伊马替尼剂量后，她因下腹痛、口腔炎和身体虚弱入院。当治疗改为α干扰素和阿糖胞苷时，下腹痛、口腔炎和身体虚弱有所改善，但骨髓穿刺显示原始细胞占36.4%。在治疗换回增加剂量的甲磺酸伊马替尼（800毫克）后，口腔炎恶化，肠道出血再次发生。内镜检查显示升结肠有多个溃疡，99mTc红细胞闪烁扫描显示大肠和小肠有病变。除输血外，患者拒绝任何治疗，十天后突然死亡。本病例提示，在开具甲磺酸伊马替尼处方时，应仔细考虑肠道出血的可能性。
