Walker Julie G, Kadia Tapan, Brown Latrondria, Juneja Harinder S, de Groot John F
Department of Neuro-Oncology, The University of Texas - M. D. Anderson Cancer Center, Houston, TX, USA.
J Neurooncol. 2009 Aug;94(1):149-52. doi: 10.1007/s11060-009-9813-8. Epub 2009 Feb 14.
Primary brain tumor patients have multiple risk factors for Pneumocystis jiroveci and may require prophylaxis with TMP-SMZ or dapsone. Although dapsone is generally safe and efficacious, we present a case of a patient diagnosed with a brain stem glioblastoma who developed methemoglobinemia and haemolytic anemia after presenting with worsening confusion and cardiopulmonary system dysfunction. This case highlights one of the potentially severe complications associated with dapsone therapy. Although this illustrates an unusual toxicity of dapsone, a high index of suspicion should be given to high-risk patients due to ethnic heritage, anemia, or advanced age. Furthermore, given the toxicities of TMP-SMZ and dapsone, further work is needed to determine the threshold CD4(+) count at which empiric prophylaxis should be initiated.
原发性脑肿瘤患者有多种感染耶氏肺孢子菌的风险因素，可能需要用复方磺胺甲恶唑或氨苯砜进行预防。尽管氨苯砜通常安全有效，但我们报告了一例脑干胶质母细胞瘤患者，该患者在出现意识障碍加重和心肺系统功能障碍后发生了高铁血红蛋白血症和溶血性贫血。该病例凸显了氨苯砜治疗相关的一种潜在严重并发症。虽然这说明了氨苯砜一种不常见的毒性，但对于因种族、贫血或高龄等因素导致的高危患者，应保持高度怀疑。此外，鉴于复方磺胺甲恶唑和氨苯砜的毒性，需要进一步研究以确定开始经验性预防时的CD4(+)细胞计数阈值。
