RESUMEN
A 71-year-old woman presented to a clinic with the chief complaint of facial edema and dyspnea; chest radiography showed mediastinal mass shadow and right pleural effusion. Computed tomography guided biopsy of the mediastinal mass had been performed by her previous doctor, and she was diagnosed with diffuse large B-cell lymphoma. She was referred to our hospital for chemotherapy. Electrocardiography performed before initiating chemotherapy showed sinus arrest for about 4 s, and Holter electrocardiography showed sinus arrest for up to about 7.4 s, which was repeatedly observed 6 times, indicating sick sinus syndrome (SSS). The mediastinal mass completely excluded the superior vena cava, and considering the risk of infection, an extracorporeal pacemaker was not inserted. We believed that the tumor effect was the cause of sinus arrest; hence, chemotherapy initiation was prioritized. R-CHOP therapy preceding vincristine and prednisolone was started, and sinus arrest was not observed after initial treatment. SSS may have been caused by carotid hypersensitivity syndrome that involved the exclusion of carotid artery pressure receptors by the tumor or the direct stimulation of the vagus nerve by microtumor infiltration.
Asunto(s)
Linfoma de Células B Grandes Difuso , Síndrome del Seno Enfermo , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Síndrome del Seno Enfermo/etiología , Síndrome del Seno Enfermo/terapia , Vena Cava Superior , Vincristina/uso terapéuticoAsunto(s)
Antibacterianos/efectos adversos , Claritromicina/efectos adversos , Muerte Súbita Cardíaca/etiología , Didesoxinucleósidos/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Lamivudine/efectos adversos , Lopinavir/efectos adversos , Piperazinas/efectos adversos , Ritonavir/efectos adversos , Conducta Sexual , Sulfonamidas/efectos adversos , Vasodilatadores/efectos adversos , Combinación de Medicamentos , Interacciones Farmacológicas , Electrocardiografía , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Purinas/efectos adversos , Citrato de SildenafilRESUMEN
Two patients developed bepridil-induced interstitial pneumonia during treatment of arrhythmia. The first patient was a 69-year-old man who received bepridil to maintain sinus rhythm in atrial fibrillation and who developed dyspnea on the 20th day after administration. The second patient was a 72-year-old man who received bepridil for paroxysmal atrial fibrillation and who developed dyspnea on the 60th day after administration. They were diagnosed with interstitial pneumonia on the basis of physical and imaging findings. The first patient was discharged after steroid pulse therapy, and the second patient after improvement of physical and imaging findings when bepridil was discontinued. Although a limited number of cases of bepridil-induced interstitial pneumonia have been reported, the disorder should be kept in mind as an important adverse reaction when breathlessness or dyspnea develops during administration of the drug.