RESUMEN
Purpose: Repeated exposure to platinum compounds increases the risk of immunoglobulin E-mediated immediate hypersensitivity reactions (HSR). To date, many different desensitization protocols with varying success rates have been reported. The presented study is aimed at disseminating the real-world experience of an interdisciplinary healthcare team focusing on platin desensitization. Patients and Methods: This is a cross-sectional, retrospective study of 7 female patients with carboplatin- or oxaliplatin-induced HSRs. After a discussion with the oncologist and the patient, desensitization protocols were performed by a team consisting of an allergy and immunology specialist, a clinical pharmacist, and a nurse. Clinical data were extracted from the patients' medical records, and HSRs were reviewed and classified by an allergist according to severity and type. Results: Twenty-five desensitization protocols were carried out for patients with carboplatin- or oxaliplatin-induced HSRs (N=4 and N=3, respectively; age range: 54-66). Two of the patients did not experience any HSR during a total of 8 desensitization cycles. The other patients had grade 1-3 HSRs on 15 cycles, which were successfully managed by oxygen and/or pharmacological interventions and infusions were resumed at a lower rate after stabilization of the patient. Compared to baseline, serum tryptase levels were elevated during HSRs (4.77±0.21 vs 9.50±1.71, P=0.028). Conclusion: All the patients were able to finish the treatment protocol and receive full chemotherapeutic doses. Interdisciplinary teams may facilitate the preparation and administration of platinum-based chemotherapeutics and increase the success rates of desensitization protocols for platin-based chemotherapy, where the concentration and application of drugs differ from standard procedure.
RESUMEN
Plasmodium vivax is the most common malaria agent in the world, transmitted by vectoring of anopheles mosquitoes. In the clinical course of the disease, non-specific signs of infection (fever, myalgia, joint pain, nausea, vomiting, etc.) can be seen. Hemophagocytic lymphohistiocytosis; also known as hemophagocytic syndrome, is a rapid-onset and life-threatening clinical condition that develops as a result of uncontrolled immune activation and hypercytokinemia. In this case report, a case who developed hemophagocytic syndrome while under treatment for P.vivax infection was presented. A 37-year-old male patient applied to us with the complaints of high fever, chills-shivering and weakness, started on his return from Sudan. Upon admission, the fever was 40°C, the pulse was rhythmic and 115/minute, the respiratory rate was 24/minute, and the blood pressure was 80/49 mmHg, and he was followed up in the intensive care unit due to the signs of systemic inflammatory response syndrome. During the investigation of the etiology of fever, it was learned that he did not receive prophylaxis for malaria during his stay in Sudan. Thin and thick blood smears were examined. P.vivax infection was detected in the patient and the treatment was initiated, a bone marrow aspiration biopsy was performed with the prediagnosis of hemophagocytic syndrome with persistent fever, deepening of thrombocytopenia, findings of hyperferritinemia, hypertriglyceridemia, hepatosplenomegaly, and myeloid serial hemophagocytosis in the 48th hour of the treatment. In addition to antimalarial therapy, clinical and laboratory response was obtained with polyclonal intravenous immunoglobulin (IVIG) therapy.
