S-1併用化学放射線療法中の口腔癌患者に生じた重篤な薬剤性腸炎の1例

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  • 田中 拓也
    熊本大学大学院生命科学研究部総合医薬科学部門感覚・運動医学講座歯科口腔外科学分野
  • 尾木 秀直
    熊本大学大学院生命科学研究部総合医薬科学部門感覚・運動医学講座歯科口腔外科学分野
  • 吉武 義泰
    伊東歯科口腔病院
  • 太田 和俊
    熊本市民病院歯科口腔外科
  • 篠原 正德
    伊東歯科口腔病院
  • 中山 秀樹
    熊本大学大学院生命科学研究部総合医薬科学部門感覚・運動医学講座歯科口腔外科学分野

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  • A case of serious drug-induced enteritis that developed during chemoradiotherapy with S-1 in a patient with oral cancer
  • S-1 ヘイヨウ カガク ホウシャセン リョウホウ チュウ ノ コウコウ ガン カンジャ ニ ショウジタ ジュウトク ナ ヤクザイセイ チョウエン ノ 1レイ

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<p>An 84-year-old woman with left mandibular gingival carcinoma received chemoradiotherapy combining S-1 (100 mg / day for 14 days) with a total dose of 20 Gy of radiotherapy. The patient had frequent diarrhea, severe myelosuppression, and renal dysfunction after therapy.</p><p>　She was therefore treated in the intensive care unit of our hospital. Abdominal computed tomography (CT) showed edema of the entire intestine, and abdominal endoscopy showed diffuse hemorrhage, mainly in the small intestine. No mucosal duct necrosis was found on histopathological examination, which was also negative for ischemic enteritis. The patient then had bloody bowel discharge, disturbed consciousness, and respiratory depression. Disseminated intravascular coagulation (DIC) was diagnosed. We intubated the trachea and started transfusion and medical treatment for DIC. The treatment reduced the symptoms and the abdominal CT findings. Chemical enterocolitis was suspected, because the endoscopy results, stool culture, and the results of the lymphocyte stimulation test for S-1 were positive. In conclusion, when a patient has frequent diarrhea during S-1 therapy, we should treat it as an aggravation of drug-induced enteritis.</p>

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