RESUMO
BACKGROUND: Toxic epidermal necrolysis (TEN) is an uncommon but life-threatening adverse drug reaction. Pemetrexed is a multitargeted antifolate. It was first used in combination with cisplatin as a front-line treatment for malignant pleural mesothelioma. The same combination is nowadays approved in the first-line setting for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). PATIENT AND METHODS: We report the case of a 50-year-old man treated for metastatic NSCLC. Within 5 days after administration of the second cycle of cisplatin and pemetrexed, he developed large blisters, which secondarily became hemorrhagic, and mucosal lesions. The characteristic clinical appearance, the histopathological findings, and the clinical course were decisive for the diagnosis of TEN. Treatment with systemic steroids and intravenous antibiotics as well as topical wound treatment led to resolution and improvement of his general condition. CONCLUSIONS: To the best of our knowledge, this is the third case of TEN due to pemetrexed in a patient with NSCLC. Clinicians should be aware of TEN as a rare but potentially fatal disorder requiring hospitalization and multidisciplinary management.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/secundário , Cisplatino/efeitos adversos , Neoplasias Pulmonares/secundário , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Antineoplásicos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cisplatino/uso terapêutico , Glutamatos/efeitos adversos , Glutamatos/uso terapêutico , Guanina/efeitos adversos , Guanina/análogos & derivados , Guanina/uso terapêutico , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pemetrexede , Síndrome de Stevens-Johnson/prevenção & controle , Resultado do TratamentoRESUMO
Phytochemical investigation of root and stem-bark of the West African medicinal plant Ongokea gore resulted in the isolation of four novel flavonoids with an unusual cyclohexyl substituent instead of the common aromatic ring B. The structures of the isolated compounds were elucidated by spectroscopic methods, mainly 1D and 2D NMR, and subsequently, the structures were corroborated by chemical conversion to (-)-(S)-sakuranetin. The absolute configurations, and preferred conformations were determined by NOE experiments and CD measurements.
Assuntos
Flavanonas/química , Olacaceae/química , Casca de Planta/química , Raízes de Plantas/química , Caules de Planta/química , Animais , Artemia , Cicloexanos/química , Cicloexanos/isolamento & purificação , Cicloexanos/farmacologia , Flavanonas/isolamento & purificação , Flavanonas/farmacologia , Medicinas Tradicionais Africanas , Modelos Químicos , Estrutura Molecular , Plantas MedicinaisRESUMO
From the methanolic extract of the seeds of the Brazilian Joannesia princeps 3,3'-bisdemethylpinoresinol and six new sesquineolignans were isolated besides the known neolignans americanol A, isoamericanol A and isoamericanin A which were found to be the major constituents. A method was developed to distinguish americanol- from isoamericanol-type compounds spectroscopically.