RESUMO
CASE STUDY: P.J. was a 69-year-old woman who was referred to a large cancer center for an evaluation of brain and lung masses presumed to be cancerous lesions. During the three months before the referral, P.J. had experienced a gradual 40 lb weight loss, shortness of breath with exertion, chest pain, lip tremor, edema and progressive weakening of lower extremities, overall fatigue, and increasing balance and gait disturbances. Her diagnostic workup revealed aspergillosis in her lungs and brain. This case study reports the process of differentiating between cancer and fungal disease, antifungal treatment modalities used, and the multidisciplinary management approach used in the care of P.J.
Assuntos
Aspergilose/tratamento farmacológico , Encefalopatias/tratamento farmacológico , Imunocompetência , Pneumopatias Fúngicas/tratamento farmacológico , Neuroaspergilose/tratamento farmacológico , Equipe de Assistência ao Paciente/organização & administração , Idoso , Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/diagnóstico , Encefalopatias/complicações , Encefalopatias/diagnóstico , Dor no Peito/microbiologia , Diagnóstico Diferencial , Interações Medicamentosas , Monitoramento de Medicamentos , Dispneia/microbiologia , Fadiga/microbiologia , Feminino , Transtornos Neurológicos da Marcha/microbiologia , Humanos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico , Neuroaspergilose/complicações , Neuroaspergilose/diagnóstico , Paraparesia/microbiologia , Seleção de Pacientes , Tomografia Computadorizada por Raios X , Redução de PesoRESUMO
BACKGROUND: Colitis is a rare but serious gastrointestinal complication associated with taxane-based chemotherapy in patients with cancer. The incidence, clinical presentation, and outcome of colitis in patients with breast carcinoma treated with taxane-based chemotherapy is not known. METHODS: The authors searched their electronic database and identified patients with breast carcinoma who were treated with taxane-based chemotherapy between January 1997 and December 1999. Patients diagnosed with colitis were identified and their presentation and clinical outcomes were analyzed. RESULTS: During the study period, 1350 patients received taxane-based chemotherapy. Sixty-four patients were admitted to The University of Texas M. D. Anderson Cancer Center (Houston, TX) (73 admissions) for gastrointestinal complications. Neutropenia and/or fever accounted for 56 of these admissions. Fourteen patients (16 admissions) were diagnosed with colitis. All had abdominal pain at median Day 6 of their chemotherapy cycle (range, 3-8 days), with or without other symptoms. Computed tomography scans of the abdomen and pelvis were abnormal for the 10 patients tested, whereas only 3 of the 9 patients who underwent radiographic abdominal series had abnormal findings. Two patients had a colonoscopy that confirmed the diagnosis of colitis. Blood cultures were positive in only 3 (20%) of 15 colitis events. All eight patients tested for Clostridium difficile toxin were negative. One patient died of sepsis. An autopsy subsequently revealed cecal ulceration. Two patients had bowel perforations requiring hemicolectomy. Colitis recurred in two patients after they resumed taxane-based chemotherapy without dose reduction. Dose reductions prevented the recurrence of colitis in seven patients. Treatment discontinuation of taxane-based chemotherapy also prevented disease recurrence. CONCLUSIONS: Acute abdominal pain in patients with breast carcinoma treated with taxane-based chemotherapy signaled a potentially fatal colitis, and warrants aggressive supportive care. Dose reduction or discontinuation of taxane-based chemotherapy may prevent the recurrence of colitis.
