塩酸ピラルビシンによるアナフィラキシーショックの1例

Abstract

75歳男.膀胱の上皮内癌に対し経尿道的膀胱腫瘍切除術を施行した.病理診断はTransitional cell carcinoma(TCC)G2であった.術後, 塩酸ピラルビシンを用いた膀胱内注入化学療法を1クール施行した.その後, 膀胱の上皮内癌を2回再発し, BCGによる化学療法が1クールづつ2回施行した.術後2年, 胸部CTで腫瘤影を認め, TCCの肺転移と診断した.塩酸ピラルビシンを用い, シスプラチンとメソトレキセートの投与量を減量して, MVAC療法による全身化学療法を施行した.塩酸ピラルビシン投与時に全身の熱感, 掻痒感を訴えたがバイタルサインに著変は認めなかった.しかし, 2クール目の塩酸ピラルビシン投与直後より顔面蒼白となり, 著明な血圧低下, 頻脈を認め, 全身の発汗, 発赤および口唇のチアノーゼを認めた.薬剤性ショックと考え塩酸ピラルビシンの投与を中止した.MVAC療法は中止したが胸部X線検査で転移巣の消失を認めた.以後, テガフール・ウラシル300mgの1日1回の内服で行っていたが, 再度同部位に転移巣を認めたため, CMV療法をを行いCRを得た

A 75-year-old man was admitted to our hospital for treatment of superficial bladder tumor. Transurethral resection (TUR) was performed and histopathological examination revealed a transitional cell carcinoma (G2). Despite one course of post-TUR bladder instillation therapy using pirarubicin hydrochloride, carcinoma in situ (CIS) was found 4 months later. CIS disappeared after another course of bladder instillation therapy using BCG; but, it recurred a month later. BCG bladder instillation therapy was performed again, and no malignant cells were detected in the urinary tract thereafter. Four months later, lung metastasis was diagnosed and an MVAC regimen (cisplatin, methotrexate, vinblastin adriamycin) was administered. However, anaphylactic shock was induced by intravenous injection of pirarubicin hydrochloride, so this therapy was stopped in the middle of the second course. Even though the lung metastasis disappeared once after the same MVAC treatment, it recurred the following year. At that time, 3 courses of a cisplatin-methotrexate-vinblastin regimen were administered, and a complete response was achieved.