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1例48岁男性左肺腺癌患者,在紫杉醇+顺铂方案化疗结束后口服厄洛替尼150mg、1次/d维持治疗。服药3d后患者出现多发性痤疮样皮疹、咳嗽、胸闷、气短。胸部CT:左侧胸腔积液,左侧胸壁、纵隔胸膜及叶间胸膜下结节较前增大,双肺下叶间质性炎性反应。给予美洛西林-舒巴坦和甲泼尼龙治疗,同时继续服用厄洛替尼。2周后患者症状缓解,停用美洛西林-舒巴坦和甲泼尼龙。厄洛替尼单药使用4d后皮疹加重,间质性肺炎复发伴间断发热,肾功能异常(BUN14.6mmol/L,SCr172μmol/L)。停用厄洛替尼,再次给予抗感染和甲泼尼龙治疗1周后患者皮疹消退,肾功能恢复正常,胸部CT示间质性炎性反应消失。
A 48-year-old male patient with left lung adenocarcinoma received erlotinib 150 mg once daily after maintenance chemotherapy with paclitaxel plus cisplatin. After taking medicine 3d patients with multiple acne-like rash, cough, chest tightness, shortness of breath. Chest CT: left pleural effusion, left chest wall, mediastinal pleura and subpleural nodules increased compared with the former, the lower lung interstitial inflammatory reaction. Give mezlocillin-sulbactam and methylprednisolone treatment while continuing to take erlotinib. Symptoms were relieved in 2 weeks, and mezlocillin-sulbactam and methylprednisolone were discontinued. Erlotinib monotherapy 4d after the rash, interstitial pneumonia relapse with intermittent fever, renal dysfunction (BUN14.6mmol / L, SCr172μmol / L). Erlotinib was discontinued. After one week of anti-infective and methylprednisolone treatment, the patient’s rash subsided and the renal function returned to normal. Chest CT showed an interstitial inflammatory reaction disappeared.