一个罕见的Pertuzumab诱导的有毒表皮解剖的罕见病例
Mohamed Zakee Mohamed Jiffry1, Felipe Carmona Pires1, Maria A Perozo1
1Internal Medicine, Danbury Hospital, Danbury, USA.
Cureus
|July 3, 2023
概括
本案例研究报告了一例罕见的有毒表皮解 (TEN) 病例,该病例发生在接受祖马布治疗HER2阳性乳腺癌的患者身上. 它强调了这种向治疗的潜在不良药物反应.
科学领域:
- 在瘤学瘤学.
- 皮肤病学 皮肤病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 珀图祖马布是针对HER2阳性乳腺癌的向治疗,抑制癌细胞生长信号.
- 毒性表皮亡 (TEN) 是对药物的严重,危及生命的皮肤反应,涉及广泛的水泡和脱落.
- 与HER2抑制剂治疗相关的TEN,比如祖马布,以前没有在医学文献中记录过.
研究的目的:
- 在患有转移性乳腺癌的患者中,在第一次服用百图祖马布后,描述了有毒表皮解 (TEN) 的病例.
- 提高人们对与HER2向治疗相关的这种潜在的严重皮肤不良药反应的认识.
主要方法:
- 一个44岁的女性患有转移性乳腺癌的病例报告.
- 珀图祖马布输注后扩散性水泡性皮疹的详细临床表现.
- 患者管理的文件,包括使用类固醇和抗组胺药物的支持性护理,以及对低血压的压力支持.
主要成果:
- 患者在12小时内出现了与TEN相一致的疼痛性,性水泡性皮疹,这与输注普尔图祖马布的12小时内一致.
- 皮疹涉及身体表面面积的10%以上,具有阳性尼科尔斯基标志.
- 尽管患有包括低血压在内的并发症,但患者通过支持性护理实现了完全康复.
结论:
- 这一案例表明,珀图祖马布 (一种HER2抑制剂) 与毒性表皮解 (TEN) 的发展之间存在潜在的联系.
- 临床医生应警接受祖马布治疗的患者发生严重的皮肤反应,即使这种情况很少发生.
- 迅速识别和支持性管理对于改善药物诱导TEN患者的治疗结果至关重要.
相关概念视频
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates these...
Drug Toxicity: Dose-Dependent Reactions
Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
Drug Toxicity: Allergic Reactions
Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial exposure to a...
Drug toxicity: Idiosyncratic Reactions
Idiosyncratic drug reactions represent abnormal chemical responses that vary significantly among individuals, ranging from extreme sensitivity to low doses to insensitivity to high doses. These reactions often occur due to the drug's covalent binding with serum proteins, forming a foreign hapten that triggers an immunotoxicological response. The variability in drug reactions has a strong pharmacogenetic foundation, with genetic differences crucial in how individuals metabolize drugs. For...
Diphtheria
Diphtheria is an acute, toxin-mediated infectious disease that primarily affects the upper respiratory tract. It is caused by Corynebacterium diphtheriae, a Gram-positive, pleomorphic rod that lacks spore-forming capability and exhibits a characteristic club-shaped morphology under microscopic examination. While C. diphtheriae can asymptomatically colonize mucosal surfaces, clinical disease manifests only when the bacterial strain is lysogenized by a specific β-corynephage. This phage...


