Delirium as the Abrupt Manifestation of Severe Anaphylactic Reaction to Oxaliplatin

Oxaliplatin是治療大腸直腸癌病患有效的藥物，曾經有一些立即型或延遲型過敏反應被報導過。它可能發生在每個輸注週期，但最常見的在第七至第九週期。多數病人之過敏情形可能發生以下症狀，包括支氣管痙攣，皮疹，血管性水腫，心搏過速，低血壓，及發燒。我們在此報導一結腸癌患者在第七次輸注oxaliplatin時發生皮膚紅疹及心搏過速之情形。在兩個星期後輸注時又發生類似症狀包括呼吸急促以及譫妄等情形。及時給予抗過敏藥物治療後，病人之意識順利恢復，沒有任何後遺症。和oxaliplatin輸注相關的過敏反應是相當罕見的，但它可以致命。及時診斷與急救措施是非常重要的。輸注oxaliplatin應謹慎，可能需要使用減敏治療，以避免相同的種過敏反應發生。

關鍵字

Oxaliplatin ；過敏症；譫妄；大腸癌

並列摘要

Hypersensitivity reactions to oxaliplatin, either immediate or delayed-type, has been reported. It may occur in each cycle of infusion but is most common in the 7(superscript th) to 9(superscript th) cycles. Most patients develop allergic events like bronchospasm, rash, angioedema, tachycardia, hypotension, and fever during or just after oxaliplatin infusion. Herein, we report a heavily pretreated colon cancer patient who presented with skin rash and tachycardia after the 7(superscript th) infusion of oxaliplatin. During the next infusion two weeks later, similar symptoms occurred again, accompanied with acute anaphylactic reaction presenting as delirium. Diphenhydramine and anti-inflammatory medication were given promptly, and the patient’s consciousness was regained without any sequela. Oxaliplatin therefore needed to be withheld, and the patient's treatment shifted to another regimen. Infusion-related allergic reaction is rare, but it can be a fatal event. To our knowledge, this is the first presented case with delirium as the first sign of anaphylactic reaction after oxaliplatin infusion. Prompt diagnosis with adequate resuscitation is important. Repeated infusion should be given carefully, and a desensitization protocol might be needed to avoid the same kind of allergic reaction.

並列關鍵字

Oxaliplatin ； Hypersensitivity ； Delirium ； Colorectal cancer

國際替代計量

Delirium as the Abrupt Manifestation of Severe Anaphylactic Reaction to Oxaliplatin

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