ActinomycinD, Unusual Reaction Or Overdose??
Q80 RPh
This is a case of an unusual reaction to ActinomycinD (Dactinomycin) at Kuwait
Cancer Control Center. Any comments that help in understanding the case will
be appreciated.
A 16 months old boy with Wilm's Tumour, Stage II was put on the STOP 93-01
protocol (with Actinomycin and vincristine) which included neoadjuvant
treatment followed by right nephrectomy, then post-operative chemotherapy with
Actinomycin, Epirubicin and Vincristine. His Actinomycin dose was 0.015 mg/kg
and since the boy's weight was less than 12 kg, only 2/3 of the dose was given.
He tolerated all the treatment very well but on his 6th post-operative cycle
he was sleepier and more tired than usual, had slight bleeding per mouth, one
spot or two. Next day the bleeding was more and the patient was not eating,
and he had melena. These symptoms were progressing slowly over the days and
were accompanied by progressive brown discoloration around the eyes and the
mouth. He also had runny nose and tonsillitis, and his temperature was around
38.5 C on two occasions. He received a cephaloporin antibiotic for that. He
received 4 days of Actinomycin and the last 5th dose was omitted. 4 days after
the last dose he presented with massive exfoliative dermatitis, severe
conjunctivitis and mucositis, non-stop bleeding from the mouth and melena. His
Hb. Was 6.5 (initial Hb prior to starting chemotherapy was 8.5). WBC of 3.5
which dropped to 2.2 next day, and then to 1.0 the day after. He was
intubated, covered with Antibiotics, blood transfusion, local treatment and
GSCF.
This patient did not receive irradiation. Actinomycin overdose has been
suspected. The pharmacists denied it. Could this be an unusual reaction to
the drug in a boy who has been taking it with no side effects whatsoever in the
past? Can this be idiosyncrisity or an anaphylactic reaction?
Dr. Shafika Al Awadhi
Kuwait Cancer Control Center
Hychkok
infected with a bacteria which progressed to hemorrhagic fever?
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