Antineoplastics
1
Reactions 1302 - 22 May 2010 ★ S Antineoplastics Oesophageal stricture (first report for dexamethasone) in infants and children: 4 case reports Four paediatric patients developed oesophageal strictures after induction chemotherapy with dexamethasone, daunorubicin, pegaspargase, vincristine and intrathecal methotrexate [dosages and duration of treatment not stated] for pre-B-cell acute lymphoblastic leukaemia (ALL). The drugs were administered according to the Medical Research Council UKALL 2003 protocol. After achieving remission with induction chemotherapy, a 17-month old male infant had systemic candidiasis which was treated with antifungals. Two weeks later, he developed persistent dysphagia and vomiting necessitating total parenteral nutrition. Barium swallow revealed a severe distal oesophageal stricture with nominal passage into the stomach. Following unsuccessful oesophageal dilation, the boy underwent oesophageal replacement. Histological examination revealed extensive inflammation of fibrous connective tissue, with discrete suppurative granulomata and large necrotic areas. Large numbers of yeast were identified. The boy received 3 weeks of amphotericin, and a repeat barium swallow showed free flow into the stomach and duodenum. A 2-year-old girl had a Candida albicans respiratory infection during induction chemotherapy which was treated with caspofungin and fluconazole. She presented with worsening vomiting which led to gradual onset of dysphagia. Barium swallow revealed a distal oesophageal stricture and a dilated proximal oesophagus with limited passage into the stomach. Biopsy of the stricture revealed squamous mucosa with minimal inflammation. Monthly oesophageal dilations were started and an open gastrostomy was conducted. The girl’s swallowing returned to normal after 6 months and her symptoms resolved. An 11-year-old boy had disseminated candidiasis during induction chemotherapy, treated with amphotericin and fluconazole. He presented with progressive dysphagia and regurgitation, and was unable to swallow solids. Barium swallow and gastroesophagoscopy revealed a discrete stricture at the lower end of the oesophagus. Inflamed granulation tissue was noted on a biopsy of a large ulcer proximal to the stricture. The boy received omeprazole and his symptoms improved. A 4-year-old boy developed oral candidiasis 3 weeks after starting chemotherapy. He was treated with a proton pump inhibitor and fluconazole. He presented 3 weeks later with worsening retrosternal pain and vomiting after ingestion of solid food. A moderate stricture at 20 cm was seen on gastroesophagoscopy, with clinical evidence of oesophageal candidiasis; C. albicans infection was confirmed on biopsy. Oesophageal dilation was performed and the boy’s symptoms improved. Kelly K, et al. Esophageal strictures during treatment for acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology 32: 124-7, No. 2, Mar 2010 - Ireland 803014106 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of oesophageal stricture associated with dexamethasone. The WHO ADR database contained four reports of oesophageal stenosis associated with dexamethasone. 1 Reactions 22 May 2010 No. 1302 0114-9954/10/1302-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1302 - 22 May 2010
★ SAntineoplastics
Oesophageal stricture (first report fordexamethasone) in infants and children: 4 casereports
Four paediatric patients developed oesophagealstrictures after induction chemotherapy withdexamethasone, daunorubicin, pegaspargase, vincristineand intrathecal methotrexate [dosages and duration oftreatment not stated] for pre-B-cell acute lymphoblasticleukaemia (ALL). The drugs were administered according tothe Medical Research Council UKALL 2003 protocol.
After achieving remission with induction chemotherapy,a 17-month old male infant had systemic candidiasis whichwas treated with antifungals. Two weeks later, hedeveloped persistent dysphagia and vomiting necessitatingtotal parenteral nutrition. Barium swallow revealed a severedistal oesophageal stricture with nominal passage into thestomach. Following unsuccessful oesophageal dilation, theboy underwent oesophageal replacement. Histologicalexamination revealed extensive inflammation of fibrousconnective tissue, with discrete suppurative granulomataand large necrotic areas. Large numbers of yeast wereidentified. The boy received 3 weeks of amphotericin, and arepeat barium swallow showed free flow into the stomachand duodenum.
A 2-year-old girl had a Candida albicans respiratoryinfection during induction chemotherapy which wastreated with caspofungin and fluconazole. She presentedwith worsening vomiting which led to gradual onset ofdysphagia. Barium swallow revealed a distal oesophagealstricture and a dilated proximal oesophagus with limitedpassage into the stomach. Biopsy of the stricture revealedsquamous mucosa with minimal inflammation. Monthlyoesophageal dilations were started and an opengastrostomy was conducted. The girl’s swallowingreturned to normal after 6 months and her symptomsresolved.
An 11-year-old boy had disseminated candidiasis duringinduction chemotherapy, treated with amphotericin andfluconazole. He presented with progressive dysphagia andregurgitation, and was unable to swallow solids. Bariumswallow and gastroesophagoscopy revealed a discretestricture at the lower end of the oesophagus. Inflamedgranulation tissue was noted on a biopsy of a large ulcerproximal to the stricture. The boy received omeprazole andhis symptoms improved.
A 4-year-old boy developed oral candidiasis 3 weeksafter starting chemotherapy. He was treated with a protonpump inhibitor and fluconazole. He presented 3 weekslater with worsening retrosternal pain and vomiting afteringestion of solid food. A moderate stricture at 20 cm wasseen on gastroesophagoscopy, with clinical evidence ofoesophageal candidiasis; C. albicans infection wasconfirmed on biopsy. Oesophageal dilation was performedand the boy’s symptoms improved.Kelly K, et al. Esophageal strictures during treatment for acute lymphoblasticleukemia. Journal of Pediatric Hematology/Oncology 32: 124-7, No. 2, Mar 2010 -Ireland 803014106
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports ofoesophageal stricture associated with dexamethasone. TheWHO ADR database contained four reports of oesophagealstenosis associated with dexamethasone.
1
Reactions 22 May 2010 No. 13020114-9954/10/1302-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
