Ganière Vincent, Christen Grégoire, Bally Frank, Guillou Louis, Pica Alessia, de Ribaupierre Sandrine, Stupp Roger
University of Lausanne Hospitals, Lausanne, Switzerland.
Nat Clin Pract Oncol. 2006 Jun;3(6):339-43; quiz following 343. doi: 10.1038/ncponc0514.
A 55-year-old man with glioblastoma multiforme was treated with continuous, dose-dense temozolomide. This therapy was curtailed after three cycles because of nausea, asthenia, and neuropsychological deterioration. During a subsequent course of radiotherapy, the patient developed fever, headaches, and cutaneous lesions.
Physical examination, cerebral MRI, brain biopsy, skin biopsy, immunohistochemistry, bronchoscopy with bronchoalveolar lavage, and laboratory tests.
Severe temozolomide-induced immunosuppression, exacerbated by corticosteroids, with profound T-cell lymphocytopenia and simultaneous opportunistic infections with Pneumocystis jiroveci pneumonia, brain abscess with Listeria monocytogenes, and cutaneous Kaposi's sarcoma.
Discontinuation of temozolomide, discontinuation of radiotherapy, antibiotic treatment with amoxicillin and gentamicin, and administration of atovaquone and pentamidine.
一名55岁的多形性胶质母细胞瘤男性患者接受了持续、剂量密集的替莫唑胺治疗。三个疗程后，由于恶心、乏力和神经心理功能恶化，该治疗中断。在随后的放射治疗过程中，患者出现发热、头痛和皮肤病变。
体格检查、脑部磁共振成像、脑活检、皮肤活检、免疫组织化学、支气管镜检查及支气管肺泡灌洗，以及实验室检查。
严重的替莫唑胺诱导的免疫抑制，因皮质类固醇而加重，伴有严重的T细胞淋巴细胞减少，同时合并耶氏肺孢子菌肺炎、单核细胞增生李斯特菌脑脓肿和皮肤卡波西肉瘤等机会性感染。
停用替莫唑胺，停止放射治疗，用阿莫西林和庆大霉素进行抗生素治疗，并给予阿托伐醌和喷他脒。
