内容紹介
A Case of Retroperitoneal Abscess Due to Acute Appendicitis during Neo-Adjuvant Chemotherapy for Breast Cancer
Summary
When acute appendicitis occurs in patients treated with chemotherapy, neutropenia and abdominal complaints caused by chemotherapy can contribute to the diagnostic difficulty, masking the increase in white blood cell(WBC)counts and physical findings of acute appendicitis. A 43-year-old premenopausal woman who was diagnosed with stageⅢA left breast cancer was scheduled for neoadjuvant chemotherapy including fluorouracil plus epirubicin plus cyclophosphamide(FEC), followed by docetaxel and trastuzumab(DOC plus HER). The patient developed fever and lower abdominal pain on day 17 of DOC plus HER cycle 1, and was diagnosed with acute gastroenteritis in the emergency room. These symptoms were almost improved 4 days later, and then cycle 2 was performed as scheduled. WBC counts decreased to 1,530 cells/μL due to DOC-induced myelosuppression on day 8 of cycle 2 when the patient developed lower abdominal pain again. However, WBC counts increased to 21,680 cells/μL on day 13 of cycle 2. Computed tomography scans revealed an intraperitoneal abscess due to acute appendicitis, and consequently urgent operation was performed. It is necessary to understand that patients with acute appendicitis during chemotherapy can present less clinical findings.
要旨
症例は43歳,女性。左乳癌(cT3N1M0,stageⅢA)と診断され,術前化学療法[fluorouracil+epirubicin+cyclophosphamide(FEC)4コース→docetaxel+trastuzumab(DOC+HER)4コース]を施行する方針となった。DOC+HER 1コース後のday 17に発熱,下腹部痛が出現したが急性胃腸炎と診断され,経過観察となった。DOC+HER 2コース目施行日には解熱し,腹痛も軽快したため予定どおり投与した。day 8に再び下腹部痛が出現したが,WBC 1,530/μLと低値であり経過観察となったが,腹痛の改善が認められず,day 13には発熱も認め,WBC 21,680/μLと上昇していた。腹部CTで急性虫垂炎による骨盤内膿瘍と診断され,緊急手術(回盲部切除術)を施行した。化学療法中は副作用である消化器症状,白血球減少や局所炎症所見の欠如などにより,急性腹症の診断が困難となりやすいと考えられる。
目次
Summary
When acute appendicitis occurs in patients treated with chemotherapy, neutropenia and abdominal complaints caused by chemotherapy can contribute to the diagnostic difficulty, masking the increase in white blood cell(WBC)counts and physical findings of acute appendicitis. A 43-year-old premenopausal woman who was diagnosed with stageⅢA left breast cancer was scheduled for neoadjuvant chemotherapy including fluorouracil plus epirubicin plus cyclophosphamide(FEC), followed by docetaxel and trastuzumab(DOC plus HER). The patient developed fever and lower abdominal pain on day 17 of DOC plus HER cycle 1, and was diagnosed with acute gastroenteritis in the emergency room. These symptoms were almost improved 4 days later, and then cycle 2 was performed as scheduled. WBC counts decreased to 1,530 cells/μL due to DOC-induced myelosuppression on day 8 of cycle 2 when the patient developed lower abdominal pain again. However, WBC counts increased to 21,680 cells/μL on day 13 of cycle 2. Computed tomography scans revealed an intraperitoneal abscess due to acute appendicitis, and consequently urgent operation was performed. It is necessary to understand that patients with acute appendicitis during chemotherapy can present less clinical findings.
要旨
症例は43歳,女性。左乳癌(cT3N1M0,stageⅢA)と診断され,術前化学療法[fluorouracil+epirubicin+cyclophosphamide(FEC)4コース→docetaxel+trastuzumab(DOC+HER)4コース]を施行する方針となった。DOC+HER 1コース後のday 17に発熱,下腹部痛が出現したが急性胃腸炎と診断され,経過観察となった。DOC+HER 2コース目施行日には解熱し,腹痛も軽快したため予定どおり投与した。day 8に再び下腹部痛が出現したが,WBC 1,530/μLと低値であり経過観察となったが,腹痛の改善が認められず,day 13には発熱も認め,WBC 21,680/μLと上昇していた。腹部CTで急性虫垂炎による骨盤内膿瘍と診断され,緊急手術(回盲部切除術)を施行した。化学療法中は副作用である消化器症状,白血球減少や局所炎症所見の欠如などにより,急性腹症の診断が困難となりやすいと考えられる。