内容紹介
A Case of Severe Enteritis Induced by Adjuvant Chemotherapy for Colon Cancer
Summary
A 77-year-old man underwent surgery for sigmoid colon cancer. He was diagnosed with Stage Ⅲa colon cancer; therefore, we initiated oral administration of adjuvant chemotherapy comprising uracil/tegafur(UFT)plus Leucovorin(LV). However, chemotherapy was stopped after 21 days because of fatigue and diarrhea. He recovered after 3 weeks, and we administered the same regimen with a dose reduction. However, he again experienced fatigue and diarrhea after 20 days; therefore, chemotherapy was discontinued. Subsequently, he was hospitalized 8 times for conditions such as diarrhea, hypoalbuminemia, and fever. Computed tomography revealed thickening of the transverse colonic wall and colonoscopy revealed colitis, which we believe was induced by UFT plus LV. Twelve months after the last chemotherapy session, he was diagnosed with Clostridium difficile colitis. Therefore, we initiated the oral administration of vancomycin, which resulted in rapid recovery from colitis. However, he developed liver metastasis and died 29 months after the initiation of chemotherapy. We believe that this severe case of intractable colitis was caused by UFT plus LV. Therefore, we report this case with a review of the literature on enteritis induced by fluorouracil-based anticancer agents in Japan.
要旨
症例は77歳,男性。Stage ⅢaのS状結腸癌の術後補助療法としてホリナート・テガフール・ウラシル療法(LV/UFT)を開始したが,疲労と下痢のため21日目で中止となった。3週間の休薬で症状が改善したためUFTを減量して再開したが,同様の症状のため20日目で中止した。その後は下痢や低アルブミン血症,発熱などを繰り返し,原癌死するまで8回の入院を要した。CT検査では横行結腸の壁肥厚を,下部消化管内視鏡検査では大腸炎を認め,臨床経過と考え合わせて抗癌剤起因性腸炎と診断した。なお,投薬中止12か月目にClostridium difficile腸炎を併発したがvancomycinの経口投与で改善した。その後に肝転移を来し,投薬中止29か月目に原癌死した。LV/UFTが誘因と考えられる難治性大腸炎を経験したので報告する。
目次
Summary
A 77-year-old man underwent surgery for sigmoid colon cancer. He was diagnosed with Stage Ⅲa colon cancer; therefore, we initiated oral administration of adjuvant chemotherapy comprising uracil/tegafur(UFT)plus Leucovorin(LV). However, chemotherapy was stopped after 21 days because of fatigue and diarrhea. He recovered after 3 weeks, and we administered the same regimen with a dose reduction. However, he again experienced fatigue and diarrhea after 20 days; therefore, chemotherapy was discontinued. Subsequently, he was hospitalized 8 times for conditions such as diarrhea, hypoalbuminemia, and fever. Computed tomography revealed thickening of the transverse colonic wall and colonoscopy revealed colitis, which we believe was induced by UFT plus LV. Twelve months after the last chemotherapy session, he was diagnosed with Clostridium difficile colitis. Therefore, we initiated the oral administration of vancomycin, which resulted in rapid recovery from colitis. However, he developed liver metastasis and died 29 months after the initiation of chemotherapy. We believe that this severe case of intractable colitis was caused by UFT plus LV. Therefore, we report this case with a review of the literature on enteritis induced by fluorouracil-based anticancer agents in Japan.
要旨
症例は77歳,男性。Stage ⅢaのS状結腸癌の術後補助療法としてホリナート・テガフール・ウラシル療法(LV/UFT)を開始したが,疲労と下痢のため21日目で中止となった。3週間の休薬で症状が改善したためUFTを減量して再開したが,同様の症状のため20日目で中止した。その後は下痢や低アルブミン血症,発熱などを繰り返し,原癌死するまで8回の入院を要した。CT検査では横行結腸の壁肥厚を,下部消化管内視鏡検査では大腸炎を認め,臨床経過と考え合わせて抗癌剤起因性腸炎と診断した。なお,投薬中止12か月目にClostridium difficile腸炎を併発したがvancomycinの経口投与で改善した。その後に肝転移を来し,投薬中止29か月目に原癌死した。LV/UFTが誘因と考えられる難治性大腸炎を経験したので報告する。