Kido Kazuhiko, Adams Val R, Morehead Richard S, Flannery Alexander H
Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA.
J Oncol Pharm Pract. 2016 Apr;22(2):335-40. doi: 10.1177/1078155214563814. Epub 2015 Apr 13.
We report the case of capecitabine-induced ventricular fibrillation arrest, possibly secondary to type I Kounis syndrome. A 47-year-old man with a history of T3N1 moderately differentiated adenocarcinoma of the colon, status-post sigmoid resection, was started on adjuvant capecitabine approximately five months prior to presentation of cardiac arrest secondary to ventricular fibrillation. An electrocardiogram (EKG) revealed ST segment elevation on the lateral leads and the patient was taken emergently to the cardiac catheterization laboratory. The catheterization revealed no angiographically significant stenosis and coronary artery disease was ruled out. After ruling out other causes of cardiac arrest, the working diagnosis was capecitabine-induced ventricular fibrillation arrest. As such, an inflammatory work up was sent to evaluate for the possibility of a capecitabine hypersensitivity, or Kounis syndrome, and is the first documented report in the literature to do so when evaluating Kounis syndrome. Immunoglobulin E (IgE), tryptase, and C-reactive protein were normal but histamine, interleukin (IL)-6, and IL-10 were elevated. Histamine elevation supports the suspicion that our patient had type I Kounis syndrome. Naranjo adverse drug reaction probability scale indicates a probable adverse effect due to capecitabine with seven points. A case of capecitabine-induced ventricular fibrillation arrest is reported, with a potential for type 1 Kounis syndrome as an underlying pathology supported by immunologic work up.
我们报告了一例卡培他滨诱发的心室颤动骤停病例，可能继发于I型库尼斯综合征。一名47岁男性，有结肠T3N1中分化腺癌病史，乙状结肠切除术后，在因心室颤动导致心脏骤停出现前约五个月开始接受卡培他滨辅助治疗。心电图（EKG）显示侧壁导联ST段抬高，患者被紧急送往心脏导管室。导管检查未发现血管造影有明显狭窄，排除了冠状动脉疾病。在排除心脏骤停的其他原因后，初步诊断为卡培他滨诱发的心室颤动骤停。因此，进行了炎症相关检查以评估卡培他滨过敏或库尼斯综合征的可能性，这是在评估库尼斯综合征时文献中首次有记录的此类报告。免疫球蛋白E（IgE）、类胰蛋白酶和C反应蛋白正常，但组胺、白细胞介素（IL）-6和IL-10升高。组胺升高支持了我们的患者患有I型库尼斯综合征的怀疑。Naranjo药物不良反应概率量表显示因卡培他滨导致的不良反应可能性为七分。本文报告了一例卡培他滨诱发的心室颤动骤停病例，免疫检查结果支持1型库尼斯综合征作为潜在病理基础的可能性。
