Kim Hyeon Seong, Lee Jae Young, Jung Ji Won, Lee Kyu Hoon, Kim Mi Jung, Park Si-Bog
Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea.
World J Clin Cases. 2021 Oct 16;9(29):8804-8811. doi: 10.12998/wjcc.v9.i29.8804.
Mannitol is a hyperosmolar agent and the combination of mannitol and furosemide is a widely used treatment for intracranial pressure control. Considering the hypertonic properties of mannitol to move water out of intracellular spaces, we hypothesized that mannitol combined with furosemide could relieve focal tissue swelling in refractory lymphedema.
A 90-year-old female had been diagnosed with intracranial hemorrhage and received a combination of mannitol and furosemide for intracranial pressure control. Independent of the intracranial hemorrhage, she had refractory lymphedema of the left lower extremity since 1998. Remarkably, after receiving the mannitol and furosemide, the patient's lower extremity lymphedema improved dramatically. After the mannitol and furosemide were discontinued, the lymphedema worsened in spite of complete decongestive therapy (CDT) and intermittent pneumatic compression treatment (IPC). To identify the presumed effect of mannitol and furosemide on the lymphedema, these agents were resumed, and the lymphedema improved again.
The present case raises the possibility that a combination of mannitol and furosemide might be considered another effective therapeutic option for refractory lymphedema when CDT and IPC are ineffective.
甘露醇是一种高渗性药物，甘露醇与呋塞米联合使用是控制颅内压的常用治疗方法。考虑到甘露醇的高渗特性可使水从细胞内空间移出，我们推测甘露醇联合呋塞米可缓解难治性淋巴水肿的局部组织肿胀。
一名90岁女性被诊断为颅内出血，并接受甘露醇和呋塞米联合治疗以控制颅内压。自1998年起，她独立于颅内出血之外，患有左下肢难治性淋巴水肿。值得注意的是，在接受甘露醇和呋塞米治疗后，患者的下肢淋巴水肿显著改善。在停用甘露醇和呋塞米后，尽管进行了完全减压治疗（CDT）和间歇性气动压迫治疗（IPC），淋巴水肿仍加重。为确定甘露醇和呋塞米对淋巴水肿的假定作用，重新使用这些药物，淋巴水肿再次改善。
本病例提示，当CDT和IPC无效时，甘露醇和呋塞米联合使用可能被视为难治性淋巴水肿的另一种有效治疗选择。
