恶性卵巢生殖细胞肿瘤辅助化疗后药物诱导性血栓性微血管病：病例报告及文献复习。
Drug-induced thrombotic microangiopathy after adjuvant chemotherapy in malignant ovarian germ cell tumor: A case report and literature review.
机构信息
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
出版信息
Taiwan J Obstet Gynecol. 2024 Nov;63(6):944-947. doi: 10.1016/j.tjog.2024.03.025.
OBJECTIVE
We presented a rare case of drug-induced thrombotic microangiopathy (DI-TMA) following chemotherapy with the regimen of bleomycin, etoposide, and cisplatin (BEP) in a patient with malignant ovarian germ cell tumor (MOGCT). The objective is to highlight the difficulty in diagnosing and treating DI-TMA associated with BEP chemotherapy.
CASE REPORT
A 21-year-old woman presented with a pelvic mass. Fertility-sparing staging surgery was performed, and a diagnosis of endodermal sinus tumor was confirmed. The patient received the first course of adjuvant chemotherapy with BEP regimen, but she developed symptoms of anemia, thrombocytopenia, and acute kidney injury. DI-TMA was diagnosed after thorough examinations, and she improved gradually by three courses of plasma exchange. Adjuvant chemotherapy was discontinued due to DI-TMA, and she kept disease-free for 17 months after the operation.
CONCLUSION
DI-TMA, a rare lethal complication in MOGCT patients receiving the BEP regimen, requires prompt diagnosis and appropriate treatments.
目的
我们报告了一例恶性卵巢生殖细胞肿瘤（MOGCT）患者在接受博来霉素、依托泊苷和顺铂（BEP）方案化疗后发生药物诱导的血栓性微血管病（DI-TMA）的罕见病例。目的是强调诊断和治疗与 BEP 化疗相关的 DI-TMA 的困难。
病例报告
一名 21 岁女性因盆腔肿块就诊。进行了保留生育力的分期手术，并确诊为内胚窦瘤。患者接受了第一疗程的 BEP 方案辅助化疗，但出现贫血、血小板减少和急性肾损伤的症状。经过全面检查后诊断为 DI-TMA，通过三疗程的血浆置换逐渐好转。由于 DI-TMA 而停止辅助化疗，术后 17 个月无疾病复发。
结论
DI-TMA 是 MOGCT 患者接受 BEP 方案治疗时罕见的致命并发症，需要及时诊断和适当治疗。
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