A Case Involving Chronic Diarrhea over an Extended Period of Time following Anticancer Treatment in a Patient with Edema and Which Was Improved by Olopatadine Administered for Another Purpose

<p>Introduction: We are reporting on our experience with a case involving chronic diarrhea that had been continuing for 14 years following anticancer treatment, in which diarrhea and the nutritional status of the patient were unintentionally improved by administered antihistamine. Subject: A 48-year-old female. Fourteen years ago, surgery, chemotherapy, and total pelvic radiotherapy were carried out for cervical cancer, immediately after which diarrhea continued. A laparotomy was performed 11 years ago for Ileus, and radiation enterocolitis was diagnosed upon pathological examination 8 years ago. One month ago, she experienced swelling of the lower limbs after acute cellulitis and visited our outpatient palliative care. Leaking edema due to low nutrition remained following the remission of lymphedema. Ten days prior to re-examination, a maximum dosage of 20 mg/day of olopatadine was prescribed by another department against urticaria, and at the same time, remission of her diarrhea was observed. Oral administration of folic acid and vitamin was completed by continuing small doses, leading to a rise in CK and disappearance of the edema. Discussion: It may be believed that chronic diarrhea was relieved by olopatadine administered for another purpose due to the inhibitory action of 5-hydroxytryptamine 2A receptor, which is a subfamily of serotinin having histamine 1 inhibitory action and the action to increase the bowel movements.</p>

A Case of Acute-phase Reaction of Denosumab which was Difficult to Exclude Aggravation of Original Cancer Pain

Introduction: We report a case of acute-phase reaction of denosumab which was difficult to exclude aggravation of original cancer pain. Case: A 65 year-old man with severe pain from right back to upper abdomen due to mid thoracic vertebral metastases of small cell lung cancer was consulted to palliative care team. Denosumab 120 mg was administered subcutaneously three times every four weeks. On the next day of first administration, pyrexia occurred. At all three administrations, pain worsened for four days after the next day of administration. The pain was worsened from numerical rating scale 2 to 6. Same phenomenon was observed each time denosumab was administered for three consecutive times. Although the area of pain overlapped with that of original vertebral metastases, the repetition of the pain exacerbation soon after the denosumab administration suggested acute-phase reaction. Conclusion: Pain aggravation caused by acute phase reaction of denosumab might be overlooked in patients with cancer pain. More investigation is needed for details of acute-phase reaction caused by denosumab.