Antineoplastics/cefepime
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Reactions 1373 - 15 Oct 2011 S Antineoplastics/cefepime Febrile neutropenia and pseudomembranous colitis in an elderly patient: case report A 74-year-old man with metastatic colon cancer developed febrile neutropenia after receiving antineoplastics [some routes not stated]. He subsequently developed pseudomembranous colitis during treatment with cefepime. The man, who had previously undergone resection surgery and sigmoid colostomy, received chemotherapy every 2 weeks with oxaliplatin 85 mg/m 2 on day 1, folinic acid [leucovorin] 100 mg/m 2 on days 1 and 2, and fluorouracil 400 mg/m 2 rapid infusion and 600 mg/m 2 continuous infusion on days 1 and 2 (FOLFOX4). He developed grade 3 neutropenia and grade 2 oral ulcers after his second course. However, he had no adverse events higher than grade 2 with subsequent administrations and received a total of five courses. Two days after completing his fifth course, he developed a fever of 40°C and grade 4 leucopenia and neutropenia. He was diagnosed with febrile neutropenia and admitted. The man received cefepime [dosage and route not stated] and a granulocyte colony-stimulating factor. From day 2, he developed diarrhoea, which subsequently worsened despite receiving fluids and an intestinal disorder drug. He continued to receive cefepime for a total of 5 days. His fever and neutropenia persisted, and CT revealed a paralytic intestinal obstruction. There was a large volume of drainage from his nasogastric tube and colostomy opening, associated with tachycardia. Cefepime was withdrawn, and he received meropenem, immune globulin and fluids. Samples for Clostridium difficile (CD) toxin testing were submitted at this time. After further analysis, he was diagnosed with disseminated intravascular coagulation (DIC) on day 7, and started gabexate. On day 9, his CD toxin test returned positive, and he was diagnosed with pseudomembranous colitis, accompanied by an intestinal obstruction and DIC. The man’s antibacterial was switched to gentamicin, and he received vancomycin enemas through his colostomy opening. His symptoms and laboratory findings subsequently improved. His intestinal obstruction disappeared and, on day 16, he was switched to oral vancomycin. He recovered and was discharged on day 34. Tsuchida K, et al. A case of pseudomembranous colitis with febrile neutropenia induced by chemotherapy and effectively treated by vancomycin enemas. Gan to Kagaku Ryoho 37: 1821-1823, No. 9, Sep 2010 [Japanese; summarised from a translation] - Japan 803061361 1 Reactions 15 Oct 2011 No. 1373 0114-9954/10/1373-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics/cefepime
Reactions 1373 - 15 Oct 2011
SAntineoplastics/cefepime
Febrile neutropenia and pseudomembranouscolitis in an elderly patient: case report
A 74-year-old man with metastatic colon cancerdeveloped febrile neutropenia after receivingantineoplastics [some routes not stated]. He subsequentlydeveloped pseudomembranous colitis during treatmentwith cefepime.
The man, who had previously undergone resectionsurgery and sigmoid colostomy, received chemotherapyevery 2 weeks with oxaliplatin 85 mg/m2 on day 1, folinicacid [leucovorin] 100 mg/m2 on days 1 and 2, andfluorouracil 400 mg/m2 rapid infusion and600 mg/m2 continuous infusion on days 1 and2 (FOLFOX4). He developed grade 3 neutropenia andgrade 2 oral ulcers after his second course. However, hehad no adverse events higher than grade 2 with subsequentadministrations and received a total of five courses. Twodays after completing his fifth course, he developed a feverof 40°C and grade 4 leucopenia and neutropenia. He wasdiagnosed with febrile neutropenia and admitted.
The man received cefepime [dosage and route not stated]and a granulocyte colony-stimulating factor. From day 2, hedeveloped diarrhoea, which subsequently worseneddespite receiving fluids and an intestinal disorder drug. Hecontinued to receive cefepime for a total of 5 days. Hisfever and neutropenia persisted, and CT revealed aparalytic intestinal obstruction. There was a large volume ofdrainage from his nasogastric tube and colostomy opening,associated with tachycardia. Cefepime was withdrawn, andhe received meropenem, immune globulin and fluids.Samples for Clostridium difficile (CD) toxin testing weresubmitted at this time. After further analysis, he wasdiagnosed with disseminated intravascular coagulation(DIC) on day 7, and started gabexate. On day 9, his CDtoxin test returned positive, and he was diagnosed withpseudomembranous colitis, accompanied by an intestinalobstruction and DIC.
The man’s antibacterial was switched to gentamicin, andhe received vancomycin enemas through his colostomyopening. His symptoms and laboratory findingssubsequently improved. His intestinal obstructiondisappeared and, on day 16, he was switched to oralvancomycin. He recovered and was discharged on day 34.Tsuchida K, et al. A case of pseudomembranous colitis with febrile neutropeniainduced by chemotherapy and effectively treated by vancomycin enemas. Gan toKagaku Ryoho 37: 1821-1823, No. 9, Sep 2010 [Japanese; summarised from atranslation] - Japan 803061361
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Reactions 15 Oct 2011 No. 13730114-9954/10/1373-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
