Fujii Tomoki, Ohno Nobuhiro, Kitahara Shinsuke, Kobayashi Seiichiro, Sahara Naohi, Matsunaga Takashi
Department of Hematology, Kantoh Rosai Hospital.
Department of Oncology, Kantoh Rosai Hospital.
Rinsho Ketsueki. 2022;63(2):117-120. doi: 10.11406/rinketsu.63.117.
An 88-year-old woman was diagnosed with multiple myeloma received third-line chemotherapy, including DBd (daratumumab [DARA], bortezomib, and dexamethasone [Dex]), and the myeloma was in remission. Sulfamethoxazole/trimethoprim (ST) prophylaxis was discontinued because the dose of Dex was reduced to 20 mg every 4 weeks after 21 cycles of DBd. After 28 cycles of DBd, altered consciousness with fever ensued, and she was referred to the emergency department where Listeria monocytogenes (LM) meningitis was diagnosed. CD38 inactivation is associated with increased LM susceptibility. In patients on Dara-based chemotherapy, antibiotic prophylaxis should be considered using ST, which has activity against Listeria.
一名88岁女性被诊断为多发性骨髓瘤，接受了包括DBd（达雷妥尤单抗[DARA]、硼替佐米和地塞米松[Dex]）的三线化疗，骨髓瘤处于缓解期。由于在21个周期的DBd治疗后地塞米松剂量减至每4周20毫克，停用了磺胺甲恶唑/甲氧苄啶（ST）预防用药。在28个周期的DBd治疗后，患者出现发热伴意识改变，被转诊至急诊科，诊断为单核细胞增生李斯特菌（LM）脑膜炎。CD38失活与LM易感性增加有关。在接受基于Dara的化疗的患者中，应考虑使用对李斯特菌有活性的ST进行抗生素预防。
