A novel ganciclovir desensitization protocol for a pediatric patient: A case report
Küçük Resim Yok
Tarih
2021
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Elsevier Masson, Corp Off
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
A nine year-old girl, having high temperature and stomach ache symptoms, was diagnosed with primary haematophagocytic lymphohistiocytosis. During the treatment, she had neutropenic fever, dyspnea and bronchospasm. Laboratory tests revealed a 7,189,566 cytomegalovirus (CMV)-DNA copies/mL. Ganciclovir therapy was started for CMV pneumonia. At the second infusion of ganciclovir, she had dyspnea, bronchospasm, tachycardia and urticaria. Adrenaline, antihistamines and corticosteroids were administered for anaphylaxis. Treatment was replaced with valganciclovir but there was no clinical or laboratory regression. Because valganciclovir was ineffective and foscarnet could not be provided, we decided to apply desensitization with ganciclovir without performing skin tests because the reaction was anaphylactic. Total dose was 350 mg, for the patient's weight of 35 kg, according to 10 mg/kg daily dose. A (1/1000 dilution), B (1/100 dilution), C (1/10 dilution) and D (no dilution) solutions were prepared. Desensitization began with a 1/10,000(e) of the therapeutic dose, followed by 14 administrations of increasing doses every 30 minutes and lasted 6.5 hours. There was no reaction during desensitization. Patient was subsequently treated with ganciclovir every day without any problem for 21 days. After the treatment, clinical symptoms resolved and CMV-DNA copies were found < 31 IU/mL. In conclusion, we present a rare case of ganciclovir hypersensitivity (allergic or non-allergic?) and a novel protocol of ganciclovir desensitization. (C) 2021 Elsevier Masson SAS. All rights reserved.
Açıklama
Anahtar Kelimeler
Anaphylaxis, Desensitization, Drug allergy, Ganciclovir, Child, General-Considerations, Rapid Desensitization, Drug Hypersensitivity, Allergy, Antibiotics
Kaynak
Revue Francaise D Allergologie
WoS Q Değeri
Q4
Scopus Q Değeri
Q4
Cilt
61
Sayı
8
