tailieunhanh - Báo cáo y học: " A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report | Oosting et al. Journal of Medical Case Reports 2010 4 10 http content 4 1 10 JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion a case report Sjoukje F Oosting1 Frans TM Peters2 Geke AP Hospers1 Nanno H Mulder1 Abstract Introduction We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract. Case presentation A 52-year-old Caucasian man presented with abdominal pain and distension malaise night sweats dysphagia and early satiety. A computed tomography scan showed massive ascites lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum. When his skin was re-examined an irregular pigmented lesion over the left clavicle measuring 15 mm X 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diagnosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg m2 every three weeks and he was discharged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X-ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U L to 1827U L supporting the conclusion that the response of gastrointestinal metastases to dacarbazine had resulted in the perforation of the patient s bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later. Conclusion Melanoma can .