title: Cytarabine syndrome despite corticosteroid premedication in an adult undergoing induction treatment for acute myelogenous leukemia.
abstract: Cytarabine syndrome is a rare clinical condition characterized by fever, malaise, myalgia, arthralgia, and/or rash that occurs after receipt of cytarabine. Our patient developed fever, malaise, and diffuse body pain shortly following cytarabine initiation despite receiving prophylactic dexamethasone. The patient's discomfort was treated with intravenous morphine and her other symptoms were controlled with a higher dose of dexamethasone. Although the exact cause is not fully understood, cytarabine syndrome is hypothesized to be an immune-mediated response following cytarabine-induced apoptosis that results in a rapid increase in proinflammatory cytokines. While there is no standard therapy for cytarabine syndrome, corticosteroids appear to play a role in the treatment and prevention of the condition by suppressing the proinflammatory response. Since our case describes the development of cytarabine syndrome despite dexamethasone, clinicians should monitor for this adverse event if patients begin exhibiting characteristics of this syndrome.
authors.affiliation: Department of Pharmacy, Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, TX, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Jirasek
authors.affiliation: Department of Pharmacy, Scott & White Memorial Hospital, Baylor Scott & White Health, Temple, TX, USA Department of Medicine, Health Science Center, Texas A&M University, Temple, TX, USA jherrington@sw.org.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Herrington
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000000981:diagnostic imaging; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010146:Pain / Q000139:chemically induced / Q000000981:diagnostic imaging; D011292:Premedication / Q000379:methods*; D013577:Syndrome
chemical_list: D000305:Adrenal Cortex Hormones; D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D003907:Dexamethasone
keywords: Ara-C; Cytarabine syndrome; corticosteroid; dexamethasone; fever