Munhoz Rodrigo Ramella, Pereira Picarelli Andrea Arvai, Troques Mitteldorf Cristina Aparecida, Feher Olavo
Centro de Oncologia, Hospital Sírio Libanês, São Paulo, Brazil.
Case Rep Oncol. 2013 Aug 8;6(2):410-5. doi: 10.1159/000354429. eCollection 2013.
Leukopenia and selective CD4+ lymphopenia represent major adverse events associated with the use of temozolomide (TMZ), an oral alkylating agent incorporated in the treatment of glioblastoma (GBM). The increased risk of opportunistic infections, including those caused by Pneumocystis jiroveci and cytomegalovirus, has been previously described in the literature. Here we report the case, the first to our knowledge, of a patient with pulmonary invasive aspergillosis immediately after the completion of chemoradiation with TMZ for GBM. Diagnosis was confirmed through a CT-guided lung biopsy, and the patient had excellent response to systemic voriconazole. This case illustrates that TMZ can be associated with severe opportunistic infections, presumably associated with T lymphocyte immune dysfunction, and patients exposed to this agent should be carefully monitored.
白细胞减少和选择性CD4+淋巴细胞减少是与替莫唑胺（TMZ）使用相关的主要不良事件，TMZ是一种用于治疗胶质母细胞瘤（GBM）的口服烷化剂。包括由耶氏肺孢子菌和巨细胞病毒引起的机会性感染风险增加，此前已有文献报道。在此我们报告首例（据我们所知）在完成TMZ同步放化疗治疗GBM后立即发生肺侵袭性曲霉病的患者。通过CT引导下肺活检确诊，患者对全身应用伏立康唑反应良好。该病例表明TMZ可能与严重的机会性感染有关，推测与T淋巴细胞免疫功能障碍有关，接触该药物的患者应仔细监测。
