Subramaniam S Ravih, Cader Rizna Abdul, Mohd Rozita, Yen Kong Wei, Ghafor Halim Abdul
University Kebangsaan Malaysia, Medical Centre, Kuala Lumpur, Malaysia.
Am J Case Rep. 2013 Sep 4;14:345-9. doi: 10.12659/AJCR.889401. eCollection 2013.
Male, 48 FINAL DIAGNOSIS: Low dose cyclophosphamide-induced acute hepatotoxicity Symptoms: Epigastric pain Medication: Withdrawal of cyclophosphamide Clinical Procedure: - Specialty: Nephrology • Hepatology • Gastroenterology • Toxicology.
Unexpected drug reaction.
Cyclophosphamide is commonly used to treat cancers, systemic vasculitides, and kidney diseases (e.g., lupus nephritis and focal segmental glomerulosclerosis). Acute adverse effects include bone marrow suppression, hemorrhagic cystitis, nausea, vomiting, and hair loss. Hepatotoxicity with high dose cyclophosphamide is well recognized but hepatitis due to low dose cyclophosphamide has rarely been described.
We report the case of a 48-year-old Chinese man with a rapidly progressive glomerulonephritis secondary to granulomatosis with polyangiitis who developed severe acute hepatic failure within 24 hours of receiving low-dose intravenous cyclophosphamide. The diagnosis of granulomatosis with polyangiitis was supported with a positive c-ANCA serology. The patient was treated with high dose methylprednisolone, plasmapheresis, intermittent hemodialysis, and low-dose intravenous cyclophosphamide.
Hepatotoxicity may occur even after low-dose intravenous cyclophosphamide treatment. To the best of our knowledge, this is the first report of severe, non-viral, liver inflammation developing within 24 hours of administration of low-dose intravenous cyclophosphamide (200 mg). Physicians should be aware of this serious adverse reaction and should not repeat the cyclophosphamide dose when there is hepatotoxicity caused by the first dose. Initial and follow-up liver function tests should be monitored in all patients receiving cyclophosphamide treatment.
男性，48岁
低剂量环磷酰胺诱发的急性肝毒性
上腹部疼痛
停用环磷酰胺
意外的药物反应
环磷酰胺常用于治疗癌症、系统性血管炎和肾脏疾病（如狼疮性肾炎和局灶节段性肾小球硬化症）。急性不良反应包括骨髓抑制、出血性膀胱炎、恶心、呕吐和脱发。高剂量环磷酰胺引起的肝毒性已广为人知，但低剂量环磷酰胺导致的肝炎鲜有报道。
我们报告了一例48岁的中国男性患者，该患者因肉芽肿性多血管炎继发快速进展性肾小球肾炎，在接受低剂量静脉注射环磷酰胺后24小时内出现严重急性肝衰竭。c-ANCA血清学阳性支持肉芽肿性多血管炎的诊断。该患者接受了大剂量甲泼尼龙、血浆置换、间歇性血液透析和低剂量静脉注射环磷酰胺治疗。
即使是低剂量静脉注射环磷酰胺治疗后也可能发生肝毒性。据我们所知，这是首次关于在给予低剂量静脉注射环磷酰胺（200mg）后24小时内发生严重非病毒性肝脏炎症的报告。医生应意识到这种严重的不良反应，当首次剂量引起肝毒性时不应重复使用环磷酰胺剂量。所有接受环磷酰胺治疗的患者均应监测初始和后续肝功能检查。
