Antineoplastics
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Reactions 961 - 26 Jul 2003 S Antineoplastics Coeliac disease: case report Coeliac disease occurred in a 50-year-old man after high- dose antineoplastic therapy for non-Hodgkin’s lymphoma. The man’s lymphoma had initially been treated with local irradiation, but after a relapse, he was treated for 16 weeks with a regimen of bleomycin, etoposide, methotrexate, vincristine, prednisolone, cyclophosphamide and doxorubicin, followed by stem cell harvest. Approximately 6 months later, he had a recurrence of symptoms so was treated with 3 cycles of dexamethasone, cytarabine and cisplatin. This treatment was followed by a high-dose regimen of lomustine 200 mg/m 2 on day -7, etoposide 1 g/m 2 on day -7, cytarabine 2 g/m 2 on days -6 and -5, and cyclophosphamide 1.8 g/m 2 on days -4, -3 and -2, followed by stem cell harvest on day 0. High-dose antineoplastic therapy was associated with diarrhoea and vomiting which persisted 6 weeks later. These symptoms resolved after treatment with metronidazole and total parenteral nutrition, but recurred after the man resumed a normal diet. He subsequently developed severe diarrhoea- induced metabolic acidosis and a chest infection. He was treated with electrolytes and recovered after 9 days. A duodenal biopsy showed villous atrophy and he was found to have IgG and IgA antigliadin antibodies. The man was placed on a gluten and lactose free diet and discharged from hospital on a regimen of oral prednisolone. At follow-up 4 weeks later, he had not experienced any further diarrhoea or vomiting, but he had a skin rash consistent with dermatitis herpetiformis, a skin manifestation of coeliac disease. Author comment: "Our patient may have had an underlying genetic tendency towards coeliac disease that was triggered by immunosuppression." Stewart AJ, et al. Coeliac disease following high-dose chemotherapy. Clinical Oncology 14: 494-496, Dec 2002 - England 807212601 1 Reactions 26 Jul 2003 No. 961 0114-9954/10/0961-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 961 - 26 Jul 2003
SAntineoplastics
Coeliac disease: case reportCoeliac disease occurred in a 50-year-old man after high-
dose antineoplastic therapy for non-Hodgkin’s lymphoma.The man’s lymphoma had initially been treated with local
irradiation, but after a relapse, he was treated for 16 weekswith a regimen of bleomycin, etoposide, methotrexate,vincristine, prednisolone, cyclophosphamide and doxorubicin,followed by stem cell harvest. Approximately 6 months later,he had a recurrence of symptoms so was treated with 3 cyclesof dexamethasone, cytarabine and cisplatin. This treatmentwas followed by a high-dose regimen of lomustine 200 mg/m2
on day -7, etoposide 1 g/m2 on day -7, cytarabine 2 g/m2 ondays -6 and -5, and cyclophosphamide 1.8 g/m2 on days -4, -3and -2, followed by stem cell harvest on day 0.
High-dose antineoplastic therapy was associated withdiarrhoea and vomiting which persisted 6 weeks later. Thesesymptoms resolved after treatment with metronidazole andtotal parenteral nutrition, but recurred after the man resumed anormal diet. He subsequently developed severe diarrhoea-induced metabolic acidosis and a chest infection. He wastreated with electrolytes and recovered after 9 days. Aduodenal biopsy showed villous atrophy and he was found tohave IgG and IgA antigliadin antibodies.
The man was placed on a gluten and lactose free diet anddischarged from hospital on a regimen of oral prednisolone. Atfollow-up 4 weeks later, he had not experienced any furtherdiarrhoea or vomiting, but he had a skin rash consistent withdermatitis herpetiformis, a skin manifestation of coeliacdisease.
Author comment: "Our patient may have had an underlyinggenetic tendency towards coeliac disease that was triggered byimmunosuppression."Stewart AJ, et al. Coeliac disease following high-dose chemotherapy. ClinicalOncology 14: 494-496, Dec 2002 - England 807212601
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Reactions 26 Jul 2003 No. 9610114-9954/10/0961-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
