Multiple drugs

Abstract

Lack of efficacy: case report An adult woman [exact age not stated] exhibited a lack of efficacy with cyclophosphamide, doxorubicin, vincristine, prednisolone, etoposide, methylprednisolone, cytarabine and asparaginase, while being treated for extranodal NK/T-cell lymphoma [routes and dosages not stated]. The woman presented at the age of 19 years with abdominal pain and fever for a month. Her immunoserum analysis showed modest inflammation, hypoalbuminemia, slight liver dysfunction, and evidence of past EBV infection. Her age, clinical symptoms and morphological characteristic ulcer, all these findings were suggestive of Crohn’s disease. Therefore, she was treated with an elemental diet, mesalamine and prednisolone. This treatment showed partial response, however, at tapering prednisolone, her symptoms re-appeared. Therefore, she received adalimumab. The treatment with adalimumab was effective for some time. However, 21 months later, abdominal pain and fever re-occurred. Therefore, prednisolone treatment was restarted. Following 9 months, she again complained about abdominal pain. Thereafter, disease management was difficult, and she developed skin ulcers after 50 months of initial presentation. Thereafter, she was diagnosed with extranodal NK/T-cell lymphoma related to chronic active Epstein–Barr virus (CAEBV). Therefore, she started receiving ciclosporin [cyclosporine A] along with prednisolone for systemic inflammation related to CAEBV, and followed by CHOP comprising of cyclophosphamide, doxorubicin, vincristine and prednisolone. However, she developed liver injury along with cholestasis and diagnosed with hemophagocytic lymphohistiocytosis due to CAEBV. Then, she received etoposide along with methylprednisolone, which little improvement in her liver injury and jaundice. Thereafter, she received ESCAP comprising of etoposide, cytarabine [cytosine arabinoside], asparaginase [L-asparaginase], methylprednisolone and prednisolone. However, her liver injury and jaundice related to the hemophagocytic lymphohistiocytosis rapidly worsened following the first dose of ESCAP. Subsequently, her disease progressed and unable to regulate it at all. Eventually, she developed multiorgan failure and died at the age of 23 years. Her autopsy findings showed no evidence of ulcer or stenotic, noncaseating granuloma on the digestive organ, and remarkable proliferation of lymphocytes in the intra-mucosal/submucosal space of the small intestine.