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Vol.49 No.6 contents | Japanese/English |
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- Case Report -
A Case of Hypersensitivity Syndrome by Drugs for Neuropathic Pain During Gefitinib Therapy
Shingen Nakamura1, Noriaki Horiuchi11Division of Internal Medicine, Health Insurance Naruto Hospital, Japan
Background. Drug-induced hypersensitivity syndrome (DIHS) is a drug reaction characterized by fever and multiple organ failure. It is rarely induced by drugs for neuropathic pain. Case. A 74-year-old woman presented with pain in the right side of the chest and was admitted to our hospital in November 2006. She had no history of smoking. After extensive examinations, adenocarcinoma in the right lung with systemic bone metastases (stage IV) was diagnosed. We gave her combination systemic chemotherapy consisting of carboplatin and paclitaxel, but since she could not tolerate it, we switched to treatment with gefitinib, which obtained partial response. Around the time when the chemotherapy regimen was changed, electric-shock-like pain in the lower legs developed. Therefore, we administered carbamazepine and mexiletine consecutively which showed immediate effects relieving the pain. Six weeks after starting gefitinib therapy, the patient developed fever, systemic rash, diarrhea, liver dysfunction, and atypical lymphocytosis. We sequentially discontinued the drugs including gefitinib, that were suspected to be responsible for these complications and administered steroids instead. However the skin rash persisted. Eight weeks after starting gefitinib therapy, the patient developed cytomegalovirus-induced interstitial pneumonia as the complication, and we diagnosed atypical DIHS due to carbamazepine or mexiletine. Gefitinib was not able to be administered again, and she died of lung cancer in July, 2007. Conclusion. The possibility of DIHS should be considered while administering drugs for neuropathic pain to patients with lung cancer, keeping in mind that DIHS can mimic the side effects of gefitinib.
key words: Drug-induced hypersensitivity syndrome, Gefitinib, Interstitial pneumonia, Lung cancer
Received: March 4, 2009
Accepted: May 8, 2009
JJLC 49 (6): 857-862, 2009
