Marunaka Yuta, Ohashi Takuma, Kubota Takeshi, Nishibeppu Keiji, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, Japan.
Surg Case Rep. 2024 Jul 25;10(1):174. doi: 10.1186/s40792-024-01976-w.
Dropped head syndrome (DHS) is caused by dysfunction of the cervical musculature. It is classified into two groups according to the cause: one is weakness of the neck extensors and the other is hypercontraction of the cervical flexors associated with Parkinson's disease and other disorders. Although some drugs have previously been reported as suspected causes of DHS, we are unaware of any reports in which oxaliplatin was suspected. In this report, we describe a case of DHS during adjuvant chemotherapy for gastric cancer, along with a review of the relevant literature.
A 72-year-old man was diagnosed with gastric cancer, cT3N0M0 cStage IIB, and underwent laparoscopic total gastrectomy with D2 lymphnode dissection and Roux-en-Y reconstruction. The operative time was 311 min, intraoperative blood loss was 40 g, and he was discharged without any post-operative complications. The histopathological diagnosis was pT4aN2M0 pStage IIIA, and S-1 + oxaliplatin (SOX) therapy was started as adjuvant chemotherapy. On the 4th course of SOX, he complained of neck heaviness and a blood test revealed that his creatine kinase (CK) level was elevated to 2464 IU/L. After consultation with an orthopedic surgeon and a neurologist, DHS due to localized cervical extensor myositis was suspected. Therefore, the 6th course of SOX was postponed, and 30 mg of oral steroids were initiated. His symptoms improved, and his CK level decreased within 2 weeks. After resuming S-1 monotherapy and tapering off oral steroids, no recurrence of symptoms has been observed.
We experienced one case of DHS during adjuvant chemotherapy for gastric cancer. If DHS develops after starting oxaliplatin, involvement of the drug should be suspected, and discontinuation of chemotherapy and introduction of oral steroids should be considered.
垂头综合征（DHS）由颈部肌肉功能障碍引起。根据病因可分为两组：一组是颈部伸肌无力，另一组是与帕金森病及其他疾病相关的颈部屈肌过度收缩。尽管此前有报道称某些药物可能是DHS的疑似病因，但我们未发现有任何关于奥沙利铂被怀疑导致DHS的报道。在本报告中，我们描述了一例胃癌辅助化疗期间发生DHS的病例，并对相关文献进行了综述。
一名72岁男性被诊断为胃癌，cT3N0M0，c期IIB，接受了腹腔镜全胃切除术、D2淋巴结清扫术及Roux-en-Y重建术。手术时间为311分钟，术中失血40克，术后无任何并发症出院。组织病理学诊断为pT4aN2M0，p期IIIA，遂开始以S-1联合奥沙利铂（SOX）进行辅助化疗。在SOX方案的第4疗程时，他主诉颈部沉重，血液检查显示其肌酸激酶（CK）水平升高至2464 IU/L。经与骨科医生和神经科医生会诊，怀疑是局限性颈部伸肌肌炎导致的DHS。因此，推迟了SOX方案的第6疗程，并开始口服30毫克类固醇。他的症状有所改善，CK水平在2周内下降。在恢复S-1单药治疗并逐渐减少口服类固醇剂量后，未观察到症状复发。
我们在胃癌辅助化疗期间遇到了一例DHS病例。如果在开始使用奥沙利铂后发生DHS，应怀疑药物有关，考虑停止化疗并使用口服类固醇。
