Pappa Efthymia, Gkeka Marina, Kiki Ifigeneia, Gourna Pagona, Christopoulos Constantinos
Internal Medicine, Sismanoglio-A. Fleming General Hospital, Athens, GRC.
Cardiology, Konstantopouleio-Patision General Hospital, Athens, GRC.
Cureus. 2021 Feb 4;13(2):e13127. doi: 10.7759/cureus.13127.
Imatinib mesylate is a tyrosine kinase inhibitor with high efficacy in the treatment of chronic myeloid leukemia (CML). Although fluid retention is a common adverse effect of imatinib, it rarely necessitates discontinuation of therapy. Isolated ascites has not been reported as a complication of imatinib therapy in patients with CML. Here, we report the case of a 72-year-old male with CML on imatinib (600 mg daily), who developed ascites two weeks after a laparoscopic hernia repair with intraperitoneal placement of a nylon mesh. The ascites was resistant to diuretic therapy and required repeated large-volume paracentesis. Discontinuation of imatinib resulted in arrest of ascites production, but reintroduction of the drug at the same dose two weeks later was rapidly followed by recurrence of ascites requiring further therapeutic paracenteses. It was postulated that peritoneal inflammation had resulted in increased capillary permeability, which was further augmented by imatinib via inhibition of platelet-derived growth factor receptor (PDGFR), a tyrosine kinase known to play a significant physiological role in the regulation of interstitial fluid pressure and capillary permeability. The possibility of developing ascites after abdominal surgery should be considered in patients receiving imatinib or related PDGFR inhibitors. In such cases, perioperative interruption of tyrosine kinase therapy might be indicated.
甲磺酸伊马替尼是一种酪氨酸激酶抑制剂，在治疗慢性粒细胞白血病（CML）方面疗效显著。尽管液体潴留是伊马替尼常见的不良反应，但很少需要停药。孤立性腹水尚未被报道为CML患者伊马替尼治疗的并发症。在此，我们报告一例72岁男性CML患者，正在接受伊马替尼治疗（每日600mg），在腹腔镜疝修补术并腹腔内放置尼龙网两周后出现腹水。该腹水对利尿剂治疗无效，需要反复进行大量腹腔穿刺放液。停用伊马替尼导致腹水生成停止，但两周后以相同剂量重新使用该药物后，腹水迅速复发，需要进一步进行治疗性腹腔穿刺放液。据推测，腹膜炎症导致毛细血管通透性增加，而伊马替尼通过抑制血小板衍生生长因子受体（PDGFR）进一步加剧了这种情况，PDGFR是一种酪氨酸激酶，已知在调节间质液压力和毛细血管通透性方面发挥重要生理作用。接受伊马替尼或相关PDGFR抑制剂治疗的患者应考虑腹部手术后发生腹水的可能性。在这种情况下，可能需要在围手术期中断酪氨酸激酶治疗。
