演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

mFOLFOX6+抗EGFR抗体療法導入後に高アンモニア脳症を来したStage IV直腸癌の2例

演題番号 : P19-8

[筆頭演者]
演者)問山 裕二:1 
[共同演者]
井出 正三:1、北嶋 貴仁:1、安田 裕美:1、藤川 裕之:1、奥川 喜永:1、吉山 繁幸:1、廣 純一郎:1、小林 美奈子:1、大井 正貴:1、荒木 俊光:1、楠 正人:1

1:三重大学・消化管小児外科

 

We experienced 2 rare cases of hyperammonemic encephalopathy after mFOLFOX6 plus anti-EGFR antibody therapy.
Case 1. A 58-year-old man with severe anemia was diagnosed with local advanced rectal cancer with multiple liver metastases, and a Hartmann's operation was performed for rectal cancer to prevent active bleeding. Then, we performed mFOLFOX6 with cetuximab therapy as 1st line chemotherapy. He showed confusion on treatment day 2 of the first therapy. MRI and CT studies detected no abnormal findings in the central nervous system. Laboratory data revealed a marked elevation of ammonemia (337mmol/ml). We diagnosed 5-FU-induced hyperammonemia, and treated him with branched-chain amino acid solutions. The symptoms of encephalopathy and hyperammonemia resolved the next day.
Case 2. A 56-year-old man with chronic renal failure complained about abdominal pain for a month. He was diagnosed with rectal cancer and multiple distant metastases including with liver, lung and peritoneum, and underwent a Hartmann's operation for an advance rectal cancer to prevent complete bowel obstruction. Then, he received mFOLFOX6 with panitumumab therapy. He brought about disturbance of consciousness on treatment day 2. On MRI and CT studies, abnormal findings were not detected in the central nervous system. On laboratory data, he was diagnosed as a hyperammonemia (498mmol/ml) induced by a 5-fluorouracil. He was treated with hemodiafiltration. The next day, symptom of encephalopathy was disappeared and serum ammonia level returned within normal range.

キーワード

臓器別:大腸・小腸

手法別:化学療法

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