内容紹介
Pneumocystis Pneumonia during Adjuvant Chemotherapy for Advanced Colon Cancer―A Case Report
Summary
We report a case of pneumocystis pneumonia(PCP)during adjuvant chemotherapy for advanced sigmoid colon cancer. A 70-year-old Japanese man was referred to our hospital after complaining of bloody stools. He was diagnosed with advanced sigmoid colon cancer, T2N2aM1b, Stage ⅣB. After 3 cycles of mFOLFOX6 plus panitumumab as first-line chemotherapy, he received FOLFIRI plus bevacizumab as second-line chemotherapy because of progressive disease. Aprepitant and steroids were administered as antiemetic agents for a short period during each chemotherapy session. During the 2 cycle of FOLFIRI plus bevacizumab, he developed a high fever without respiratory symptoms. Chest CT revealed ground-glass opacities in both the lungs. We first treated him with antibiotics(PIPC/TAZ plus GRNX), suspecting bacterial pneumonia. However, based on the elevation of serum β-D-glucan(148 pg/mL), we diagnosed PCP and initiated SMX/TMP in addition to PIPC/TAZ. The inflammation promptly decreased, and follow-up chest CT revealed the disappearance of the ground-glass opacities. If a patient develops a fever or respiratory symptoms during a course of chemotherapy, we should consider the possibility of PCP and perform careful examinations.
要旨
大腸癌化学療法中に発症したニューモシスチス肺炎(pneumocystis pneumonia: PCP)の1例を経験した。症例は,70歳,男性。排便時出血を主訴に受診。進行S状結腸癌(T2N2aM1b,Stage ⅣB)と診断し,一次治療としてmFOLFOX6+panitumumabを3サイクル,二次治療としてFOLFIRI+bevacizumabを行った。ステロイド剤は制吐薬適正使用ガイドラインに準じた。二次治療2サイクル目より38℃台の発熱を認めた。胸部CT検査で両側肺野にすりガラス影を認めた。炎症反応の上昇を認めたため,抗生剤投与を開始した。β-D-glucan値の上昇(148 pg/mL)を認め,PCPと診断した。ST合剤を併用投与したところ,速やかに炎症反応は低下し,すりガラス影は消失した。ステロイド長期投与や放射線治療の治療歴がなくても,担癌状態,抗癌剤投与や加齢はPCP発症例の危険因子となり得る。抗癌治療中に発熱や呼吸器症状がみられる場合には,本症例も念頭に置いた諸検査が必要と考える。
目次
Summary
We report a case of pneumocystis pneumonia(PCP)during adjuvant chemotherapy for advanced sigmoid colon cancer. A 70-year-old Japanese man was referred to our hospital after complaining of bloody stools. He was diagnosed with advanced sigmoid colon cancer, T2N2aM1b, Stage ⅣB. After 3 cycles of mFOLFOX6 plus panitumumab as first-line chemotherapy, he received FOLFIRI plus bevacizumab as second-line chemotherapy because of progressive disease. Aprepitant and steroids were administered as antiemetic agents for a short period during each chemotherapy session. During the 2 cycle of FOLFIRI plus bevacizumab, he developed a high fever without respiratory symptoms. Chest CT revealed ground-glass opacities in both the lungs. We first treated him with antibiotics(PIPC/TAZ plus GRNX), suspecting bacterial pneumonia. However, based on the elevation of serum β-D-glucan(148 pg/mL), we diagnosed PCP and initiated SMX/TMP in addition to PIPC/TAZ. The inflammation promptly decreased, and follow-up chest CT revealed the disappearance of the ground-glass opacities. If a patient develops a fever or respiratory symptoms during a course of chemotherapy, we should consider the possibility of PCP and perform careful examinations.
要旨
大腸癌化学療法中に発症したニューモシスチス肺炎(pneumocystis pneumonia: PCP)の1例を経験した。症例は,70歳,男性。排便時出血を主訴に受診。進行S状結腸癌(T2N2aM1b,Stage ⅣB)と診断し,一次治療としてmFOLFOX6+panitumumabを3サイクル,二次治療としてFOLFIRI+bevacizumabを行った。ステロイド剤は制吐薬適正使用ガイドラインに準じた。二次治療2サイクル目より38℃台の発熱を認めた。胸部CT検査で両側肺野にすりガラス影を認めた。炎症反応の上昇を認めたため,抗生剤投与を開始した。β-D-glucan値の上昇(148 pg/mL)を認め,PCPと診断した。ST合剤を併用投与したところ,速やかに炎症反応は低下し,すりガラス影は消失した。ステロイド長期投与や放射線治療の治療歴がなくても,担癌状態,抗癌剤投与や加齢はPCP発症例の危険因子となり得る。抗癌治療中に発熱や呼吸器症状がみられる場合には,本症例も念頭に置いた諸検査が必要と考える。