一例淋巴瘤治疗前首次接触拉布立酶即发生致命性过敏反应的病例报告。
A case report of fatal anaphylaxis on first exposure to rasburicase just before lymphoma treatment.
作者信息
Utsu Yoshikazu, Kaneda Natsuho, Kawakami Makio, Masuda Shin-Ichi, Arai Hironori, Shimoji Sonoko, Matsumoto Rena, Tsushima Takafumi, Tanaka Kazusuke, Matsuo Kosuke, Kimeda Chiharu, Konno Shiho, Aotsuka Nobuyuki
机构信息
Department of Medical Oncology, Japanese Red Cross Narita Hospital, 90-1, Iida-Cho, Narita, 286-8583, Japan.
Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Narita, Japan.
出版信息
Allergy Asthma Clin Immunol. 2024 Oct 26;20(1):58. doi: 10.1186/s13223-024-00920-9.
BACKGROUND
Rasburicase, a recombinant urate oxidase enzyme, has potent efficacy in controlling uric acid and is widely used to prevent tumor lysis syndrome in high-risk patients owing to its low toxicity profile. However, it has been associated with a risk of anaphylaxis, especially on re-exposure, owing to its immunogenic potential.
CASE PRESENTATION
A 71-year-old Japanese female diagnosed with diffuse large B cell lymphoma with a large tumor burden experienced anaphylactic shock leading to death upon initial administration of rasburicase. The pre-and postmortem examination revealed that the cause of death was a cascade of events starting with anaphylaxis-induced distributive shock leading to obstructive shock due to the collapse of the heart, which was compressed by the post-mediastinal tumor. This was further compounded by massive bleeding from the tumor and tension hemothorax, resulting in circulatory collapse.
CONCLUSIONS
Although extremely rare, rasburicase can cause fatal anaphylaxis, even on first exposure.
背景
拉布立酶是一种重组尿酸氧化酶，在控制尿酸方面具有强大功效，因其低毒性特征而被广泛用于预防高危患者的肿瘤溶解综合征。然而，由于其免疫原性，它与过敏反应风险相关，尤其是再次接触时。
病例报告
一名71岁的日本女性被诊断为弥漫性大B细胞淋巴瘤，肿瘤负荷较大，在首次使用拉布立酶时发生过敏性休克并导致死亡。生前和死后检查显示，死亡原因是一系列事件，始于过敏反应引起的分布性休克，进而因后纵隔肿瘤压迫心脏导致心脏衰竭而引发梗阻性休克。肿瘤大量出血和张力性血胸使情况进一步恶化，导致循环衰竭。
结论
尽管极为罕见，但拉布立酶即使在首次接触时也可能导致致命的过敏反应。
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