RESUMO
Background: We report a 54-year-old woman with an stage IIA (T2N0M0) RE and RP negative and HER2-positive ductal invasive breast cancer who developed a reversible cardiotoxicity associated with chemotherapy. After surgery, she received four cycles of doxorubicin and cyclophosfamide. Later, she used paclitaxel and trastuzumab. At the 7th cycle of trastuzumab, she had symptoms of heart failure with left ventricle ejection fraction = 59%. Trastuzumab dosage was reduced in 25%, and heart function progressively improved. Two years after her discharge, the patient remains asymptomatic. Systolic function of the left ventricle was normal before the initial dosis of trastuzumab, but significantly worsened following the beginning of drug administration. Moreover, a clear improvement of heart function was observed soon after the daily dose of trastuzumab was reduced. Better knowledge of risk factors for cardiotoxicity related to chemotherapy, and longstanding surveillance with serial echocardiograms can avoid more severe cardiotoxicity by chemotherapy.
Se reporta un caso de cardiotoxicidad asociada con quimioterapia con trastuzumab, en una mujer con 54 años de edad que presentó un cáncer de mama ductal invasivo, con receptores de estrógeno y de progesterona negativos y HER2-positivo, en estadio IIA (T2N0M0). En el posoperatorio, recibió cuatro ciclos de doxorubicina y ciclofosfamida. Después recibió paclitaxel y trastuzumab. En el séptimo ciclo de trastuzumab, la paciente presentó síntomas de falla cardiaca, con fracción de eyección de ventrículo izquierdo = 59%. La dosis de trastuzumab fue reducida en 25%, y la función cardiaca se normalizó progresivamente. Más de 2 años después del alta hospitalaria, permanece sin síntomas. En esta paciente la función sistólica de ventrículo izquierdo estaba normal previo al uso de trastuzumab y hubo un significativo deterioro desde el início de este medicamento. Se observó una mejoría importante en la función cardiaca cuando se redujo la dosis diaria de trastuzumab. Un mejor conocimiento acerca de los factores de riesgo para cardiotoxicidad relacionados con quimioterapia y el seguimiento prolongado con ecocardiogramas pueden evitar la cardiotoxicidad más severa debida a quimioterapia.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Insuficiência Cardíaca/induzido quimicamente , Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Ecocardiografia , Insuficiência Cardíaca/prevenção & controle , Volume Sistólico/efeitos dos fármacosRESUMO
We report a case of recurrent deep venous thrombosis in a 44-year-old woman, intravenous drug user and HIV-infected, who injected cocaine in the groins and veins of the dorsum of the feet. She suffered several episodes of deep venous thrombosis and soft-tissue infections in the lower limbs. Images of Doppler ultrasound scan revealed thrombosis in the right popliteal vein with partial recanalization and calcified thrombi in the territory of the right femoral vein. After use of heparin and oral anticoagulation, her clinical evolution was uneventful, and she was asymptomatic at the occasion of the hospital discharge. This report calls for better awareness about injections in the groins and superficial femoral veins, which are part of the deep venous system. Thrombosis related to HIV infection is highlighted.
RESUMO
We report a 54-year-old woman with an stage IIA (T2N0M0) RE and RP negative and HER2-positive ductal invasive breast cancer who developed a reversible cardiotoxicity associated with chemotherapy. After surgery, she received four cycles of doxorubicin and cyclophosfamide. Later, she used paclitaxel and trastuzumab. At the 7th cycle of trastuzumab, she had symptoms of heart failure with left ventricle ejection fraction = 59%. Trastuzumab dosage was reduced in 25%, and heart function progressively improved. Two years after her discharge, the patient remains asymptomatic. Systolic function of the left ventricle was normal before the initial dosis of trastuzumab, but significantly worsened following the beginning of drug administration. Moreover, a clear improvement of heart function was observed soon after the daily dose of trastuzumab was reduced. Better knowledge of risk factors for cardiotoxicity related to chemotherapy, and longstanding surveillance with serial echocardiograms can avoid more severe cardiotoxicity by chemotherapy.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Insuficiência Cardíaca/induzido quimicamente , Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Ecocardiografia , Feminino , Insuficiência Cardíaca/prevenção & controle , Humanos , Pessoa de Meia-Idade , Volume Sistólico/efeitos dos fármacos , TrastuzumabRESUMO
Relata-se o caso de uma mulher jovem assintomática com carcinoma de mama disseminado, que foi diagnosticado no puerpério. Foram detectadas metástases nos ossos, nos pulmões, no fígado e no sistema nervoso central. A paciente foi tratada com quimioterapia intravenosa (paclitaxel e bevacizumabe), além de radioterapia para a lesão no putâmen. Câncer de mama associado à gravidez constitui uma condição de mau prognóstico devido à demora no diagnóstico, e sua incidência tem aumentado nas últimas décadas. Embora considerada condição incomum e os relatosde caso sejam relativamente escassos, sua real frequência pode estar subestimada. A identificação dessa neoplasia durante a gravidez ou a lactação pode constituir um desafio devido à possibilidade de confundi-la com alterações fisiológicas das mamas. Recentes controvérsias sobre o uso de bevacizumabe no câncer de mama são comentadas
The case of an asymptomatic young woman with a widespread breast cancer, which was diagnosed in the puerperium is reported. Metastases were detected in the bones, lungs(?), liver and central nervous system. The patient was treated with intravenous chemotherapy (paclitaxel and bevacizumab), and radiotherapy for the lesion on putamen. Pregnancy-associated breast cancer constitutes a condition of poor prognosis due to diagnosis delay and its incidence has increased in the last decades. Although considered an uncommon condition, and case reports arerelatively scarce its real frequency may be underestimated. The identification of this neoplasm during pregnancy or lactation may be challenging, due to the possibility of misdiagnosis with physiologic changes of the breasts. Recent controversies about the utilization of bevacizumab in breast cancer are commented.
RESUMO
Relata-se o caso de uma mulher com 69 anos com obstrução biliar, para enfatizar desafios no diagnóstico e no tratamento do colangiocarcinoma hilar (tumor de Klatskin). Classificado como Bismuth-Corlette tipo II, o tumor poderia ser ressecado, mas o caso foi considerado inoperável, na ocasião do diagnóstico, devido a condições clínicas. Foram realizadas drenagens biliares paliativas (percutânea e endoscópica). O óbito ocorreu por insuficiência renal e choque séptico.
A 69-year-old woman presenting with biliary stricture is reported, to emphasize diagnosis and treatment challenges about hilar cholangiocarcinoma (Klatskin tumor). Classified as Bismuth-Corlette type II, the tumor could be resectable, but the patient was considered inoperable at occasion of diagnosis, due to her clinical conditions. Palliative biliary drainages (percutaneous transhepatic and endoscopic) were performed. She died due to renal failure and septic shock.
RESUMO
Objetivo. Descrever dados clínicos, laboratoriais e de anatomia patológica em uma paciente portadora de arteritede Takayasu coexistente com tuberculose. Enfatiza-se o papel dos estudos de autopsia para revelar associaçõesentre enfermidades que podem permanecer sem diagnóstico ou não informadas, quando se baseia exclusivamenteem dados clínicos.Relato do caso. Descreve-se o caso de mulher com 17 anos de idade, portadora de arterite de Takayasu coexistentecom sequelas de tuberculose no pulmão e em linfonodos. Ela apresentou síncope e ausência de pulso nobraço direito provavelmente devido à síndrome do roubo da subclávia.Conclusão. A associação causal entre a arterite de Takayasu e tuberculose tem sido sugerida, mas o papel doMycobacterium tuberculosis não está completamente esclarecido nessa condição. Essa arterite é rara em nossopaís, mas sua prevalência vem aumentando. Embora a freqüência de tuberculose seja elevada no Brasil, estudos deautopsia sobre a arterite de Takayasu concomitante com tuberculose têm sido muito raramente publicados.
Objective. Clinical, laboratory and pathology findings are described in a patient with Takayasu?s arteritis coexistingwith tuberculosis, and the role of the autopsy studies is emphasized to detect associations between diseases, whichmay persist underdiagnosed or underreported if strictly based on the clinical data.Case report. The case of a 17-year-old female with Takayasu?s arteritis coexistent with lung and lymph nodesequels of tuberculosis is described. She presented with syncope and absence of pulse in the right arm likely due tosubclavian steal syndrome.Conclusion. Causal association between Takayasu?s arteritis and tuberculosis has been suggested, but the pathogenicrole of Mycobacterium tuberculosis is not entirely clear in this condition. This arteritis is rare in our country, but itsprevalence has increased. Although the prevalence of tuberculosis is high in Brazil, autopsy studies of simultaneousTakayasu?s arteritis and tuberculosis have been very rarely published.