Kataria Pritam Sureshchandra, Kendre Pradip Piraji, Patel Apurva A
Department of Medical Oncology, GCRI, Ahmedabad, Gujarat, India.
J Pharmacol Pharmacother. 2017 Jan-Mar;8(1):38-40. doi: 10.4103/jpp.JPP_182_16.
Central nervous system (CNS) toxicity has been reported in approximately 10%-30% of patients receiving intravenous infusions of ifosfamide. Encephalopathy is a rare but serious CNS adverse reaction in these patients, and although usually transient and reversible, may cause persistent neurological dysfunction or death. Clinical features range from fatigue and confusion to coma and death. Ifosfamide forms backbone of various treatment regimens including curative treatment and palliative chemotherapy regimen. Precipitation of ifosfamide-induced encephalopathy (IIE) by aprepitant has been reported in the literature rarely. Ifosfamide is moderately emetogenic; hence, aprepitant is used to prevent emesis induced by ifosfamide. We here report a case where a patient of recurrent B-cell Philadelphia-negative acute lymphoblastic lymphoma was given aprepitant to prevent ifosfamide-induced emesis. After 24 h of ifosfamide infusion, the patient developed symptoms of encephalopathy, i.e., headache, vomiting, and one episode of seizure which was followed by disoriented behavior. After doing all routine investigations and neuroimaging, the diagnosis of IIE was kept on clinical grounds, and after looking for the various factors, we came across injection fosaprepitant as the precipitating factor. On the clinical grounds, the patient was treated with hydration and injection methylene blue for above complaints, and the patient recovered without any residual deficit within 48-72 h. Hence, in the presence of causative agent, i.e., ifosfamide and precipitating agent injection fosaprepitant with negative imaging and normal laboratory parameters as well as the early and good response to methylene blue, the diagnosis of IIE precipitated by aprepitant was confirmed.
据报道，在接受异环磷酰胺静脉输注的患者中，约10%-30%会出现中枢神经系统（CNS）毒性。脑病是这些患者中一种罕见但严重的中枢神经系统不良反应，虽然通常是短暂且可逆的，但可能导致持续性神经功能障碍或死亡。临床特征从疲劳、意识模糊到昏迷和死亡不等。异环磷酰胺是包括根治性治疗和姑息性化疗方案在内的各种治疗方案的核心药物。文献中很少报道阿瑞匹坦诱发异环磷酰胺所致脑病（IIE）。异环磷酰胺有中度致吐性；因此，阿瑞匹坦用于预防异环磷酰胺引起的呕吐。我们在此报告一例复发性B细胞费城阴性急性淋巴细胞白血病患者，给予阿瑞匹坦预防异环磷酰胺引起的呕吐。在异环磷酰胺输注24小时后，患者出现脑病症状，即头痛、呕吐和一次癫痫发作，随后出现定向障碍行为。在进行所有常规检查和神经影像学检查后，根据临床情况诊断为IIE，在寻找各种因素后，我们发现注射用福沙匹坦是诱发因素。基于临床情况，针对上述症状对患者进行了补液和注射亚甲蓝治疗，患者在48-72小时内康复，无任何遗留缺陷。因此，在存在致病因素即异环磷酰胺和诱发因素注射用福沙匹坦、影像学检查阴性且实验室参数正常以及对亚甲蓝早期反应良好的情况下，确诊为阿瑞匹坦诱发的IIE。
