Severe hyponatremia in a patient with mantle cell lymphoma treated with bortezomib: a case report and review of the literature

[Central nervous system toxicity caused by bortezomib: five case reports and a review of literature]

目的

探讨硼替佐米中枢神经系统（CNS）毒性的临床特点、诊断和治疗。

方法

报道5例由硼替佐米引起的CNS毒性患者并结合现有文献探讨其临床特点。

结果

5例患者中有4例在应用硼替佐米后出现了中枢性发热，主要表现为持续性高热、周身无汗、未能找到感染病灶、对退热药不敏感，停用硼替佐米后症状好转。4例患者中有3例伴随顽固性低钠血症，1例明确诊断为抗利尿不当综合征（SIAD），可能是硼替佐米同时影响了下丘脑体温调节中枢和抗利尿激素神经分泌细胞所致。1例患者诊断为可逆性后部脑病综合征（PRES），表现为应用硼替佐米后出现意识障碍，头CT示双侧半卵圆中心白质密度减低，停用硼替佐米后患者症状消失且未再复发。此外，我们还发现血小板计数可能与硼替佐米CNS毒性的严重程度相关。

结论

硼替佐米的CNS毒性非常罕见，表现为3种形式：SIAD、PRES和中枢性发热，及时识别和治疗对于预防不可逆的神经并发症非常重要。

Natural killer/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion: A case report and review of literature

We report a case of natural killer (NK)/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient was a 64-year-old woman with a history of nasopharyngeal carcinoma of over 30 years. She was admitted with a chief complaint of intermittent fever for 2 mo. Palpation after admission indicated a swollen lymph node below the left jaw. Multiple imaging examinations on admission indicated multiple enlarged lymph nodes throughout the body. We performed a left submandibular lymph node biopsy, and the results revealed NK/T-cell lymphoma. A biochemical examination indicated Epstein-Barr virus positivity. At the same time, the patient developed hyponatremia. Based on her laboratory examination and clinical manifestation, decreased plasma osmolality, urine osmolality greater than plasma osmolality, lack of skin swelling, normal blood pressure, normal renal function, no adrenal function detected on serology, and no abnormalities in imaging examination of the adrenal glands, the likelihood of SIADH in the patient was high. After fluid restriction and administration of sodium chloride, the patient’s blood sodium level gradually increased. Subsequently, the immune function of the patient declined, there were severe symptoms of infection, and she died of respiratory failure. NK/T-cell lymphoma associated with SIADH has not, to our knowledge, been previously reported in PubMed. This case emphasizes the importance of monitoring serum ion levels, especially serum sodium, in patients with NK/T-cell lymphoma.

Bortezomib as a probable cause of the syndrome of inappropriate antidiuretic hormone secretion: A case report and review of the literature

Bortezomib is a proteasome inhibitor that has been widely adopted for the treatment of hematological malignancies, including multiple myeloma and lymphoma, and has been considered significantly more tolerable compared with traditional chemotherapeutic drugs. Bortezomib has some potential side effects that involve a number of systems, including the gastrointestinal, hematological, nervous and musculoskeletal systems; however, involvement of the endocrine system is rare. We herein report the case of a patient treated for multiple myeloma who developed the syndrome of inappropriate antidiuretic hormone secretion after bortezomib was added to his chemotherapy regimen. Following treatment with an infusion of hypertonic saline and fluid restriction for >2 months, the serum sodium level gradually recovered.