RESUMO
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Vasoespasmo Coronário/induzido quimicamente , Fluoruracila/efeitos adversos , Idoso de 80 Anos ou mais , Angina Pectoris/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/terapia , Stents Farmacológicos , Eletrocardiografia , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Masculino , Nifedipino/administração & dosagem , Nitroglicerina/administração & dosagem , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Leclercia adecarboxylata, a motile, gram-negative bacillus of the enterobacteriaceae family, is rarely recovered as a pathogen. We report an exceptionally rare case of L. adecarboxylata endocarditis complicated by embolization of the kidney and spleen in a 48-year-old woman with endometrial cancer. After 4 weeks of antimicrobial treatment, she recovered without sequelae.
Assuntos
Endocardite Bacteriana/complicações , Neoplasias do Endométrio/complicações , Infecções por Enterobacteriaceae/complicações , Enterobacteriaceae/patogenicidade , Adenocarcinoma/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Infarto/etiologia , Rim/irrigação sanguínea , Pessoa de Meia-Idade , Infarto do Baço/etiologiaRESUMO
We report a rare case of spontaneous rupture of idiopathic thymic abscess into the pleural cavity. A 64-year-old woman was admitted to hospital with pleuritic retrosternal chest pain. Chest roentgenograms disclosed a small amount of bilateral pleural effusion, the examination of which exposed a sterile serous exudate with a markedly increased CA-125 level. Chest computed tomography revealed a large anterior mediastinal cystic mass with bilateral pleural effusions. Following complete resection of the mass, the histological examination revealed cavitary lesion with necrotic thymic tissue and inflammatory infiltrate surrounded by fibrous wall. The immunohistochemical staining for CA-125 displayed strong positivity at the Hassall's corpuscles. Cyst fluid also revealed a highly elevated CA-125 level. Her serum CA-125 concentration two months after surgery had fallen to 28 IU/L. She is now doing well without recurrence of the cyst five months after surgery.