Dominguez Lisette, Tatar Furkan, Malakooti Shahdi K, Kulchinsky Robert P
Neurology, Mayo Clinic, Jacksonville, USA.
Internal Medicine, Orange Park Medical Center, Orange Park, USA.
Cureus. 2019 Jun 26;11(6):e5004. doi: 10.7759/cureus.5004.
We report a case of a 43-year-old African American female patient with otherwise stable sickle cell disease (SCD) in which use of megestrol acetate for appetite stimulation quickly potentiated her prothrombotic state within just a few days. This resulted in infarcts involving the bilateral cerebral hemispheres suggestive of embolic infarcts and the patient was subsequently confirmed to have a patent foramen ovale (PFO). A widespread literature search in PubMed revealed that this is a rare case in the literature and that the effects of megestrol acetate use in patients with SCD have not been well studied. Future research should focus on the risks of initiating megestrol acetate therapy to develop an advanced risk assessment algorithm in patients with SCD as the risk of thromboembolism may far outweigh the potential benefits.
我们报告了一例43岁的非裔美国女性患者，其镰状细胞病（SCD）病情原本稳定，但使用醋酸甲地孕酮刺激食欲后，仅在几天内就迅速加剧了她的血栓前状态。这导致双侧大脑半球出现梗死，提示为栓塞性梗死，随后该患者被确诊患有卵圆孔未闭（PFO）。在PubMed上进行的广泛文献检索显示，这是文献中罕见的病例，且醋酸甲地孕酮在SCD患者中的作用尚未得到充分研究。未来的研究应聚焦于启动醋酸甲地孕酮治疗的风险，以便为SCD患者开发先进的风险评估算法，因为血栓栓塞的风险可能远超过潜在益处。
