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Un caso de síndrome de hipersensibilidad inducida por fármacos causado por Apalutamida
Yuki Tanaka1, Yui Fujimura1, Koya Morishita1
1Okazaki City Hospital Okazaki Aichi Japan.
IJU case reports
|September 5, 2025
Resumen
La apalutamida, utilizada para el cáncer de próstata, puede causar en raras ocasiones el síndrome de hipersensibilidad inducida por fármacos (SIH). El reconocimiento inmediato y el tratamiento con esteroides e IVIG pueden controlar eficazmente esta reacción adversa grave.
Área de la Ciencia:
- En el campo de la oncología
- Farmacología
- Toxicología
Sus antecedentes:
- La apalutamida es un antagonista de los receptores de andrógenos crucial en el tratamiento del cáncer de próstata.
- El síndrome de hipersensibilidad inducida por fármacos (SHIH) es una reacción adversa rara pero grave.
- La identificación temprana y el tratamiento de DIHS son vitales para los resultados de los pacientes.
Objetivo del estudio:
- Notificar un caso de síndrome de hipersensibilidad inducida por fármacos (SHIH) asociado con el tratamiento con apalutamida en un paciente con cáncer de próstata.
- Hacer hincapié en la presentación clínica, los criterios de diagnóstico y el tratamiento exitoso del DIHS inducido por apalutamida.
- Para resaltar la importancia de la vigilancia del DIHS en los pacientes que reciben apalutamida.
Principales métodos:
- Un estudio de caso de un varón de 75 años con cáncer de próstata metastásico tratado con apalutamida y un antagonista de la GnRH.
- Monitoreo clínico de eventos adversos, incluidos sarpullido, disfunción hepática (clasificación CTCAE) y fiebre.
- Evaluación diagnóstica para el DIHS basada en criterios establecidos.
- Tratamiento con prednisolona y inmunoglobulina intravenosa (IVIG) en el momento del diagnóstico.
Principales resultados:
- El paciente desarrolló sarpullido de grado 2, disfunción hepática de grado 3 y fiebre tres semanas después de iniciar el tratamiento con apalutamida.
- Los síntomas progresaron a erupción de grado 3 y disfunción hepática de grado 4, cumpliendo con los cinco criterios diagnósticos del DIHS.
- La interrupción del tratamiento con apalutamida y el tratamiento con prednisolona e IVIG condujo a una rápida mejora de la fatiga, la erupción cutánea y la función hepática.
- El paciente toleró el tratamiento posterior con abiraterona y un antagonista de la GnRH sin recurrencia de eventos adversos.
Conclusiones:
- La apalutamida puede precipitar el síndrome de hipersensibilidad inducida por fármacos (DIHS), lo que requiere un cuidadoso control del paciente.
- El reconocimiento inmediato y la intervención con corticosteroides y IVIG son efectivos en el tratamiento del DIHS inducido por apalutamida.
- El monitoreo periódico en el laboratorio y la vigilancia clínica son esenciales para los pacientes sometidos a tratamiento con apalutamida para mitigar el riesgo de reacciones adversas graves.
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