Reactions 1256 - 13 Jun 2009

SAntineoplastics

Neutropenia and mucosal disorders: case reportAn about 37-year-old man developed neutropenia and

severe mucositis, culminating in regurgitation of hisoesophageal mucosa, while receiving high-dosechemotherapy with carmustine, etoposide, cytarabine[Aracytine] and melphalan [dosages and duration oftreatments to onset of reactions not stated].

The man had been diagnosed with stage IV nodularsclerosing Hodgkin lymphoma in 2005, aged 35 years, andhad undergone treatment according to the ABVD regimen(doxorubicin, bleomycin, vincristine and dacarbazine). Hepresented with mediastinal relapse in 2007. After threecourses of MINE therapy (mitoguazone, ifosfamide,vinorelbine and etoposide), high-dose chemotherapy withcarmustine, etoposide, cytarabine and melphalan (BEAM)was initiated; he also underwent autologous stem celltransplantation. While receiving BEAM, he developedintractable nausea, severe oral mucositis and grade IVneutropenia. On examination on day +20, he reportedsevere throat pain and nausea, and subsequentlyregurgitated a long red and white flesh-like object, whichwas identified as his entire oesophageal mucosa. Furtherinvestigations of the expelled specimen revealed mucosalnecrosis with preservation of the basal membrane.Subsequent clinical examination showed no abnormalities,bleeding or choking. He made an uneventful recoverywithout evidence of oesophageal dysfunction [neutropeniaoutcome not stated].

Author comment: "This spectacular case demonstrates theextensive damage caused by chemotherapies on themucosa . . . repeated episodes of vomiting may have favoredthe regurgitation of the damaged esophageal mucosa."Canaud G, et al. Clinical challenges and images in GI. Gastroenterology 136: 1508& 1847, No. 5, May 2009 - France 801146019

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Reactions 13 Jun 2009 No. 12560114-9954/10/1256-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved