Division of Pediatric Intensive Care, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey.
Division of Pediatric Intensive Care, Department of Pediatrics, Medical School, Ankara University, Ankara, Turkey.
Transfus Apher Sci. 2021 Oct;60(5):103173. doi: 10.1016/j.transci.2021.103173. Epub 2021 Jun 18.
Except for side effects expected standart dose use of the chemotherapeutics agents, toxic effects (poisoning) may occur if high doses of are mistakenly used in the treatment of haemato-oncological diseases and these toxic doses are usually fatal. Here, we report a case of Stevens Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN) following administration of toxic dose of vinblastine by mistake. A 20-month-old male patient with a diagnosis of Langerhans Cell Histiocytosis (Letterer-Siwe) at the pediatric oncology department was admitted to intensive care unit, after having received treatment protocol consisting of vinblastine, etoposide and prednisolone, with fever, altered consciousness and decompensated shock findings. Skin biopsy which performed from bullous lesions in the perianal, neck and axillary regions was resulted compatible with SJS / TEN in the patient with multiple organ failure, at 48 h of admission. It was later determined that the patient has been mistakenly given 10 times the normal dose of vinblastine he needed (60 mg/m), which was 6 mg/m. Plasma exchange was performed 3 times for vinblastine toxicity, intravenous immunoglobulin was administered for SJS / TEN therapy and phenobarbital was initiated to increase drug metabolism. The patient whose clinical picture fully improved, was transferred to the oncology department on the 30th day of intensive care hospitalization. Vinblastine toxicity is a life-threatening condition that can cause multiple organ failure, SJS / TEN. Plasma exchange is an effective treatment method for the removal of vinblastine from the body and in these cases of toxicity.
除了标准剂量的化疗药物的副作用外，如果在治疗血液肿瘤疾病时错误地使用高剂量，也可能会出现毒性作用（中毒），而这些毒性剂量通常是致命的。在这里，我们报告了一例因误给长春新碱毒性剂量而导致 Stevens Johnson 综合征（SJS）/中毒性表皮坏死松解症（TEN）的病例。一名 20 个月大的男性患者，在儿科肿瘤科被诊断为朗格汉斯细胞组织细胞增生症（Letterer-Siwe），在接受长春新碱、依托泊苷和泼尼松龙治疗方案后，因发热、意识改变和失代偿性休克而入住重症监护病房。从肛周、颈部和腋窝的水疱性病变进行的皮肤活检显示，患者存在多器官衰竭，符合 SJS/TEN，入院后 48 小时。后来确定患者被错误地给予了正常剂量的 10 倍长春新碱（60mg/m2），即 6mg/m2。为了治疗长春新碱毒性，进行了 3 次血浆置换，为 SJS/TEN 治疗给予了静脉注射免疫球蛋白，并开始使用苯巴比妥以增加药物代谢。该患者的临床症状完全改善，在重症监护住院 30 天后转入肿瘤科。长春新碱毒性是一种危及生命的疾病，可导致多器官衰竭、SJS/TEN。血浆置换是从体内去除长春新碱的有效治疗方法，在这些毒性情况下。
