Patel Kishan, Dang Adrian, Makhlouf Mai M, Raman Alex G, Abdulla Nihal E
College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA.
Department of Oncology, Los Alamitos Medical Center, Los Alamitos, USA.
Cureus. 2023 Feb 4;15(2):e34634. doi: 10.7759/cureus.34634. eCollection 2023 Feb.
The clinical course of a patient with chemotherapy-related diarrhea (CRD) refractory to standard therapy was monitored over the course of 21 days. The patient was minimally responsive to traditional treatment options, including bismuth subsalicylate, diphenoxylate-atropine, loperamide, octreotide, and oral (PO) steroids, and exhibited reportable improvements with the addition of intravenous (IV) methylprednisolone to other antidiarrheal agents. We present a case of CRD in an 82-year-old female. She was initiated on chemotherapy three weeks prior and has experienced severe diarrhea since her initiation. Despite the use of first-line antidiarrheal therapies, including loperamide, diphenoxylate-atropine, and octreotide, both subcutaneously and via continuous infusion drip, no infectious cause was found. She also received the non-absorbing corticosteroid budesonide, but her diarrhea persisted. After experiencing severe hypotension and hypovolemia secondary to profuse diarrhea, she was placed on IV steroids, which quickly reduced her symptoms. The patient was then transitioned to oral steroids and discharged on a tapering regimen. We recommend using IV steroids to treat CRD if first-line therapies fail. Utilizing IV steroids efficiently and effectively can decrease the symptoms of persistent diarrhea and lead to rapid recovery.
在21天的时间里对一名化疗相关腹泻（CRD）患者的临床病程进行了监测，该患者对标准治疗无效。患者对包括次水杨酸铋、地芬诺酯-阿托品、洛哌丁胺、奥曲肽和口服（PO）类固醇在内的传统治疗选择反应甚微，在其他止泻药物中添加静脉注射（IV）甲泼尼龙后症状有所改善。我们报告一例82岁女性的CRD病例。她在三周前开始化疗，自化疗开始后就出现严重腹泻。尽管使用了一线止泻疗法，包括皮下注射和持续静脉滴注洛哌丁胺、地芬诺酯-阿托品和奥曲肽，但未发现感染原因。她还接受了不吸收的皮质类固醇布地奈德治疗，但腹泻仍持续。在经历了因大量腹泻导致的严重低血压和血容量不足后，她接受了静脉注射类固醇治疗，症状迅速减轻。随后患者转为口服类固醇，并以逐渐减量的方案出院。我们建议，如果一线治疗失败，可使用静脉注射类固醇治疗CRD。有效且高效地使用静脉注射类固醇可以减轻持续性腹泻的症状并促进快速康复。
