内容紹介
A Case of Pneumocystis Pneumonia during Chemotherapy for Recurrent Ovarian Cancer
Summary
A 53-year-old patient with recurrent ovarian clear cell adenocarcinoma developed fever(39℃)and cough on day 28 of liposomal doxorubicin chemotherapy, the 4th cycle of the 4th regimen since initial treatment. Drug-induced interstitial pneumonia was suspected from a chest CT image showing diffuse ground-glass opacities; however, we deduced pneumocystis pneumonia from the elevated serum beta-D-glucan levels. After effective treatment with sulfamethoxazole and amphotericin B, the patient's symptoms and radiological findings improved. Pneumocystis pneumonia is an opportunistic infection that poses a risk not only for patients undergoing aggressive immunosuppressive therapy, those infected with HIV, and those with transplants, but also for patients undergoing chemotherapy. When pneumonia is diagnosed during chemotherapy, it is essential to consider the possibility of pneumocystis pneumonia.
要旨
症例は53歳,女性。卵巣明細胞癌再発例に対し,初回治療から4レジメン目にliposomal doxorubicin単剤化学療法を開始し,4サイクル目のday 28に,39℃台の発熱と咳嗽が出現した。胸部CTにてびまん性すりガラス陰影を認め,画像からは薬剤性間質性肺炎も疑われたが,β-D-glucan高値のためニューモシスチス肺炎と診断した。ST合剤とamphotericin Bを投与したところ著効し,自覚症状ならびに画像所見も改善した。ニューモシスチス肺炎は日和見感染であり,強力な免疫抑制療法時やHIV感染者,臓器移植患者のみならず,抗癌剤による化学療法時にも発症するリスクがある。癌化学療法中の肺炎をみた場合,本疾患も鑑別診断にあげることが肝要である。
目次
Summary
A 53-year-old patient with recurrent ovarian clear cell adenocarcinoma developed fever(39℃)and cough on day 28 of liposomal doxorubicin chemotherapy, the 4th cycle of the 4th regimen since initial treatment. Drug-induced interstitial pneumonia was suspected from a chest CT image showing diffuse ground-glass opacities; however, we deduced pneumocystis pneumonia from the elevated serum beta-D-glucan levels. After effective treatment with sulfamethoxazole and amphotericin B, the patient's symptoms and radiological findings improved. Pneumocystis pneumonia is an opportunistic infection that poses a risk not only for patients undergoing aggressive immunosuppressive therapy, those infected with HIV, and those with transplants, but also for patients undergoing chemotherapy. When pneumonia is diagnosed during chemotherapy, it is essential to consider the possibility of pneumocystis pneumonia.
要旨
症例は53歳,女性。卵巣明細胞癌再発例に対し,初回治療から4レジメン目にliposomal doxorubicin単剤化学療法を開始し,4サイクル目のday 28に,39℃台の発熱と咳嗽が出現した。胸部CTにてびまん性すりガラス陰影を認め,画像からは薬剤性間質性肺炎も疑われたが,β-D-glucan高値のためニューモシスチス肺炎と診断した。ST合剤とamphotericin Bを投与したところ著効し,自覚症状ならびに画像所見も改善した。ニューモシスチス肺炎は日和見感染であり,強力な免疫抑制療法時やHIV感染者,臓器移植患者のみならず,抗癌剤による化学療法時にも発症するリスクがある。癌化学療法中の肺炎をみた場合,本疾患も鑑別診断にあげることが肝要である。