抗がん治療後の長期間にわたる慢性下痢症が浮腫を契機に明らかになり，偶然投与されたオロパタジンによって改善した1例
【緒言】抗がん治療後14年間続いていた慢性下痢症が，偶然投与された抗ヒスタミン薬によって下痢や栄養状態の改善を認めた症例を経験した．【症例】48歳，女性．14年前，子宮頸がんに対し，手術，化学療法，全骨盤放射線治療施行後下痢が続いた．11年前にイレウスで開腹術，8年前病理検査で放射線性腸炎と診断された．1カ月前には蜂窩織炎後下肢浮腫を認め緩和ケア外来を受診．軽快後は低栄養による漏出性浮腫が残った．再受診10日前に蕁麻疹に他科よりオロパタジン最大20 mg/日の処方がされ，ほぼ同時に下痢の軽快を認めた．5 mgの継続投与で，葉酸，ビタミン内服は終了でき，クレアチニンキナーゼの上昇，浮腫も消失した...
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| Published in | Palliative Care Research Vol. 12; no. 2; pp. 516 - 520 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本緩和医療学会
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1880-5302 |
| DOI | 10.2512/jspm.12.516 |
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| Abstract | 【緒言】抗がん治療後14年間続いていた慢性下痢症が，偶然投与された抗ヒスタミン薬によって下痢や栄養状態の改善を認めた症例を経験した．【症例】48歳，女性．14年前，子宮頸がんに対し，手術，化学療法，全骨盤放射線治療施行後下痢が続いた．11年前にイレウスで開腹術，8年前病理検査で放射線性腸炎と診断された．1カ月前には蜂窩織炎後下肢浮腫を認め緩和ケア外来を受診．軽快後は低栄養による漏出性浮腫が残った．再受診10日前に蕁麻疹に他科よりオロパタジン最大20 mg/日の処方がされ，ほぼ同時に下痢の軽快を認めた．5 mgの継続投与で，葉酸，ビタミン内服は終了でき，クレアチニンキナーゼの上昇，浮腫も消失した．【考察】慢性下痢症が他の目的で投与されたオロパタジンで軽快したのは，ヒスタミン1阻害作用，腸蠕動亢進作用を持つセロトニンのサブファミリーである5-hydroxytryptamine 2A受容体阻害作用によると考えられた． |
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| AbstractList | 【緒言】抗がん治療後14年間続いていた慢性下痢症が，偶然投与された抗ヒスタミン薬によって下痢や栄養状態の改善を認めた症例を経験した．【症例】48歳，女性．14年前，子宮頸がんに対し，手術，化学療法，全骨盤放射線治療施行後下痢が続いた．11年前にイレウスで開腹術，8年前病理検査で放射線性腸炎と診断された．1カ月前には蜂窩織炎後下肢浮腫を認め緩和ケア外来を受診．軽快後は低栄養による漏出性浮腫が残った．再受診10日前に蕁麻疹に他科よりオロパタジン最大20 mg/日の処方がされ，ほぼ同時に下痢の軽快を認めた．5 mgの継続投与で，葉酸，ビタミン内服は終了でき，クレアチニンキナーゼの上昇，浮腫も消失した．【考察】慢性下痢症が他の目的で投与されたオロパタジンで軽快したのは，ヒスタミン1阻害作用，腸蠕動亢進作用を持つセロトニンのサブファミリーである5-hydroxytryptamine 2A受容体阻害作用によると考えられた． |
| Author | 貫田, みゆき 有賀, 悦子 上野, 美樹 |
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| References | 3) Xu X, Zhang D, Zhang H, et al. Neutrophil histamine contributes to inflammation in mycoplasma pneumonia. J Exp Med 2006; 203: 2907-17. 8) Salvador MT, Murillo MD, Rodríguez-Yoldi MC, et al. Effects of serotonin on the physiology of the rabbit small intestine. Can J Physiol Pharmacol 2000; 78: 359-66. 4) Marshall JS, Jawdat DM. Mast cells in innate immunity. J Allergy Clin Immunol 2004; 114: 21-7. 5) Berger M, Gray JA, Roth BL. The expanded biology of serotonin. Annu Rev Med 2009; 60: 355-66. 7) Gershon MD. 5-Hydroxytryptamine (serotonin) in the gastrointestinal tract. Curr Opin Endocrinol Diabetes Obes 2013; 20: 14-21. 2) Sharif NA, Xu SX, Miller ST, et al. Characterization of the ocular antiallergic and antihistaminic effects of olopatadine (AL-4943A), a novel drug for treating ocular allergic diseases. J Pharmacol Exp Ther 1996; 278: 1252-61. 14) Sung DJ, Noh HJ, Kim JG, et al. Serotonin contracts the rat mesenteric artery by inhibiting 4-aminopyridine-sensitive Kv channels via the 5-HT2A receptor and Src tyrosine kinase.Exp Mol Med 2013; 45: e67. 10) Grudell AB, Camilleri M, Carlson P, et al. An exploratory study of the association of adrenergic and serotonergic genotype and gastrointestinal motor functions. Neurogastroenterol Motil 2008; 20: 213-9. 12) Yeoh E, Horowitz M, Russo A, et al. Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study. Am J Med 1993; 95: 397-406. 15) Costedio MM, Coates MD, Danielson AB, et al. Serotonin signaling in diverticular disease. J Gastrointest Surg 2008; 12: 1439-45. 16) Doutre M. Physiopathology of urticaria. Eur J Dermatol 1999; 9: 601-5. 9) Hoyer D, Clarke DE, Fozard JR, et al. International Union of Pharmacology classification of receptors for 5-hydroxytryptamine (Serotonin). Pharmacol Rev 1994; 46: 157-203. 13) Husebye E, Hauer-Jensen M, Kjørstad K, et al. Severe late radiation enteropathy is characterized by impaired motility of proximal small intestine. Dig Dis Sci 1994; 39: 2341-9. 1) 後藤晃久，澁澤幸一，榊原陸治，他．抗アレルギー薬，塩酸オロパタジンおよびロラタジンの各種受容体に対する作用の検討．薬理と治療2002; 30: 973-8. 6) Sikander A, Rana SV, Prasad KK. Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta 2009; 403: 47-55. 11) Berthrong M, Fajardo LF. Radiation injury in surgical pathology. Part II. Alimentary tract. Am J Surg Pathol 1981; 5: 153-78. |
| References_xml | – reference: 14) Sung DJ, Noh HJ, Kim JG, et al. Serotonin contracts the rat mesenteric artery by inhibiting 4-aminopyridine-sensitive Kv channels via the 5-HT2A receptor and Src tyrosine kinase.Exp Mol Med 2013; 45: e67. – reference: 12) Yeoh E, Horowitz M, Russo A, et al. Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study. Am J Med 1993; 95: 397-406. – reference: 16) Doutre M. Physiopathology of urticaria. Eur J Dermatol 1999; 9: 601-5. – reference: 15) Costedio MM, Coates MD, Danielson AB, et al. Serotonin signaling in diverticular disease. J Gastrointest Surg 2008; 12: 1439-45. – reference: 1) 後藤晃久，澁澤幸一，榊原陸治，他．抗アレルギー薬，塩酸オロパタジンおよびロラタジンの各種受容体に対する作用の検討．薬理と治療2002; 30: 973-8. – reference: 4) Marshall JS, Jawdat DM. Mast cells in innate immunity. J Allergy Clin Immunol 2004; 114: 21-7. – reference: 6) Sikander A, Rana SV, Prasad KK. Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta 2009; 403: 47-55. – reference: 2) Sharif NA, Xu SX, Miller ST, et al. Characterization of the ocular antiallergic and antihistaminic effects of olopatadine (AL-4943A), a novel drug for treating ocular allergic diseases. J Pharmacol Exp Ther 1996; 278: 1252-61. – reference: 13) Husebye E, Hauer-Jensen M, Kjørstad K, et al. Severe late radiation enteropathy is characterized by impaired motility of proximal small intestine. Dig Dis Sci 1994; 39: 2341-9. – reference: 8) Salvador MT, Murillo MD, Rodríguez-Yoldi MC, et al. Effects of serotonin on the physiology of the rabbit small intestine. Can J Physiol Pharmacol 2000; 78: 359-66. – reference: 3) Xu X, Zhang D, Zhang H, et al. Neutrophil histamine contributes to inflammation in mycoplasma pneumonia. J Exp Med 2006; 203: 2907-17. – reference: 10) Grudell AB, Camilleri M, Carlson P, et al. An exploratory study of the association of adrenergic and serotonergic genotype and gastrointestinal motor functions. Neurogastroenterol Motil 2008; 20: 213-9. – reference: 11) Berthrong M, Fajardo LF. Radiation injury in surgical pathology. Part II. Alimentary tract. Am J Surg Pathol 1981; 5: 153-78. – reference: 5) Berger M, Gray JA, Roth BL. The expanded biology of serotonin. Annu Rev Med 2009; 60: 355-66. – reference: 7) Gershon MD. 5-Hydroxytryptamine (serotonin) in the gastrointestinal tract. Curr Opin Endocrinol Diabetes Obes 2013; 20: 14-21. – reference: 9) Hoyer D, Clarke DE, Fozard JR, et al. International Union of Pharmacology classification of receptors for 5-hydroxytryptamine (Serotonin). Pharmacol Rev 1994; 46: 157-203. |
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| Title | 抗がん治療後の長期間にわたる慢性下痢症が浮腫を契機に明らかになり，偶然投与されたオロパタジンによって改善した1例 |
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