title: [Anaphylaxia induced by etoposide--a case report].
abstract: A 32-year-old woman, gravida 4, para 2, visited Teikyo University Hospital with complaints of abnormal uterine bleeding and lower abdominal pain. Urine hCG level was 1,024 x 10(3) IU/l. MRI examination showed a vascular, rich solid mass 10 cm in diameter at the posterior region of the uterus. Under the clinical diagnosis of choriocarcinoma, she underwent total hysterectomy with right salpingooophorectomy. The ovarian choriocarcinoma was confirmed by pathologic examination. Additional chemotherapy was planned using the combined regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin. After 2 min of etoposide administration (100 mg/m2), the patient complained of acute dyspnea, which was caused by bronchospasms and cutaneous flushing. Etoposide infusion was immediately stopped, and anti-anaphylaxic treatment was done by administering hydroxyzine hydrochloride. Five min after the episode had occurred, the patient recovered. This episode was thought to have been induced by etoposide, but etoposide was a key agent for choriocarcinoma. Thus, we devised a modified chemotherapy using etoposide as follows. The regimen was hydrocortisone 100 mg i.v. q6 h and promethazine hydrochloride 50 mg i.m. q6 h for 24 h before infusion of etoposide. The etoposide concentration was diluted to 50%, and the drug administration rate reduced by half. With the modified regimen, the patient showed no anaphylaxic symptoms. The few reports on anaphylaxic reactions to chemotherapeutic agents induced by side effects must be taken into account when we use these drugs.
authors.affiliation: Dept. of Obstetrics and Gynecology, Teikyo University School of Medicine.
authors.forename: Akinori
authors.initials: A
authors.lastname: Taguchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Takeshita
authors.forename: Ryouta
authors.initials: R
authors.lastname: Machida
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hori
authors.forename: Keiko
authors.initials: K
authors.lastname: Aida
authors.forename: Ushio
authors.initials: U
authors.lastname: Furuya
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ohe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Murase
authors.forename: Norio
authors.initials: N
authors.lastname: Shinozuka
authors.forename: Takuya
authors.initials: T
authors.lastname: Ayabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mori
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced*; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D002822:Choriocarcinoma / Q000188:drug therapy; D005047:Etoposide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide