Tripathi Reva, Chugh Preeta Kaur, Verma Vertika, Mala Y M
Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India.
BMJ Case Rep. 2013 Jun 12;2013:bcr2012008000. doi: 10.1136/bcr-2012-008000.
Methotrexate is used judiciously, only when specifically indicated. However, in this case the patient had a fatal outcome after only three doses. A young nulliparous woman diagnosed as having high-risk persistent trophoblastic disease was considered for multidrug chemotherapy. However, because of persistent low-grade fever it was decided to give only single agent, methotrexate. She developed severe toxicity which proved fatal, even before the first course could be completed. Analysing causes of this rare, unexpected outcome of methotrexate administration, suggested that estimation of serum levels can be a useful tool in monitoring patients showing hypersensitivity but this facility is rarely available especially in low-resource countries. Pharmacogenetical analysis of blood/tissue sample may be useful to help in identifying patients likely to show hypersensitivity reaction.
甲氨蝶呤仅在有明确指征时谨慎使用。然而，在该病例中，患者仅接受三剂治疗后便出现了致命结局。一名被诊断为高危持续性滋养细胞疾病的未育年轻女性，原本考虑进行多药化疗。然而，由于持续低热，决定仅给予单药甲氨蝶呤。她出现了严重毒性，甚至在第一个疗程尚未完成之前就已致命。分析甲氨蝶呤给药这一罕见且意外结局的原因表明，血清水平测定可能是监测出现超敏反应患者的有用工具，但这种检测手段在资源匮乏的国家尤其少见。对血液/组织样本进行药物遗传学分析可能有助于识别可能出现超敏反应的患者。
