Inoue Y, Niimi A, Kudo T, Yoshizaki U, Sato Y, Kume H
Department of Urology The New Tokyo Hospital Chiba Japan.
Department of Urology Tokyo Metropolitan Bokutoh Hospital Tokyo Japan.
IJU Case Rep. 2025 Jun 16;8(4):411-414. doi: 10.1002/iju5.70055. eCollection 2025 Jul.
Docetaxel is a key treatment for castration-resistant prostate cancer and is administered with prednisolone, which increases the risk of steroid-induced diabetes. Its myelosuppressive effect also increases vulnerability to febrile neutropenia. Metformin is widely used for glycemic control; however, elderly cancer patients are particularly susceptible to metformin-associated lactic acidosis, necessitating careful management of sick-day and febrile neutropenia during chemotherapy.
We report a 70-year-old male with castration-resistant prostate cancer and diabetes mellitus who developed febrile neutropenia on Day 5 following docetaxel initiation. He progressed to shock with severe metabolic acidosis on Day 7 and died despite intensive care, including continuous renal replacement therapy. A retrospective review revealed continued metformin use despite prodromal fatigue and loss of appetite, likely due to impaired judgment.
This case may have involved septic shock, but metformin likely worsened the lactic acidosis. It highlights the need for sick-day education and monitoring in elderly cancer patients.
多西他赛是去势抵抗性前列腺癌的关键治疗药物，通常与泼尼松龙联合使用，这会增加类固醇诱导的糖尿病风险。其骨髓抑制作用还会增加发热性中性粒细胞减少的易感性。二甲双胍广泛用于血糖控制；然而，老年癌症患者特别容易发生与二甲双胍相关的乳酸性酸中毒，因此在化疗期间需要谨慎管理患病日和发热性中性粒细胞减少。
我们报告了一名70岁患有去势抵抗性前列腺癌和糖尿病的男性，在开始使用多西他赛后第5天出现发热性中性粒细胞减少。他在第7天进展为伴有严重代谢性酸中毒的休克，尽管接受了包括持续肾脏替代治疗在内的重症监护，但仍死亡。回顾性分析显示，尽管有前驱疲劳和食欲不振，但仍继续使用二甲双胍，这可能是由于判断力受损所致。
该病例可能涉及感染性休克，但二甲双胍可能加重了乳酸性酸中毒。它强调了对老年癌症患者进行患病日教育和监测的必要性。
