疑似Zoledronic acid導致急性前葡萄膜炎之案例報導

A Possible Zoledronic Acid Related Acute Anterior Uveitis

蘇建豪(Chien-Hao Su) ； 郭錫恭(Hsi-Kung Kuo) ； 鐘文宏(Wen-Hung Chung) ； 王郁青(Yu-Chin Lily Wang)

《台灣醫學》 19卷1期 (2015/01) Pp. 17-22

https://doi.org/10.6320/FJM.2015.19(1).03

摘要

雙磷酸鹽因可抑制蝕骨細胞調節骨頭再吸收，目前被廣泛應用於伯哲氏症（Paget's disease）、骨質疏鬆症、惡性腫瘤高血鈣以及預防癌骨轉移相關的併發症。一般病人對其耐受性良好，約30-50%於第一次輸注後會發生發燒、發冷與肌肉疼痛等輕微且短暫的急性期症狀。通常可預防性給予acetaminophen或其他非類固醇抗發炎藥以減緩不適。然當誘發眼部發炎症狀時，及早察覺診斷、中斷藥品並給予適當治療，則是預防不可逆眼部損傷之不二法門。對於可否再度給與相關製劑目前尚無共識，同時是否與特定基因相關也少有研究被發表。本篇報導一位轉移性乳癌病人於第一次使用zoledronic acid後發生急性期反應（acute phase reaction, APR）伴隨急性前葡萄膜炎（acute anterior uveitis, AAU）的案例，除提醒大家這常見但可能被忽略的不良反應外，進一步討論發生時治療策略與後續藥品使用的參考。

關鍵字

雙磷酸鹽 ； zoledronic acid ； 葡萄膜炎 ； 急性期反應

並列摘要

Bisphosphonates inhibit osteoclast activity to regulate bone resorption, are currently widely used in Paget's disease, osteoporosis, malignancy-associated hypercalcemia and prevention of complications from bone metastasis. Bisphosphonates are generally well-tolerated and about 30-50% of population after first infusion develop acute mild and transient symptoms such as fever, chills and muscle pain. Acetaminophen and other non-steroidal anti-inflammatory drugs pre-medication may relieve symptoms. However, early diagnosis and appropriate management is the only way to prevent irreversible damage to the eye from bisphosphonate-associated ocular inflamed reaction. There is no consensus on the safety of re-administration of offending or drugs of similar structure, and few relevant pharmacogenetic studies were published. We reported a case who developed acute phase reaction with acute anterior uveitis after first zoldedronic acid infusion. In additional to reminding health professionals of this common but easily overlooked adverse drug reaction, the drug treatment strategies were also discussed in this article.

並列關鍵字

Bisphosphonate ； zoledronic acid ； uveitis ； acute-phase reaction

參考文獻

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