A Case of Sudden Onset Septicemia in Recurred Gastric Cancer Following S1 Plus Docetaxel Treatment
A 72-year-old man having recurrent lymph node metastases from gastric cancer was admitted to Saiseikai Sendai Hospital to receive chemotherapy for gastric cancer. He had a history of distal gastrectomy plus right hepatic lobectomy for advanced gastric cancer with liver metastases (). As paraaortic lymph node metastases had re-grown despite 17 courses of combination chemotherapy of paclitaxel (Bristol-Myers Squibb, NY, US) and S-1 (Taiho Pharmaceutical CO., LTD, Tokyo, Japan), the chemotherapy regime was changed to drip infusion of docetaxel (Sanofi-aventis, Paris, France). He showed no definite adverse effects at the first administration of docetaxel in short term hospitalization. This was the second treatment of docetaxel. On admission, he looked well-being and blood chemistry data showed no inflammatory disease. Before chemotherapy, abdominal CT showed neither metastasis nor abscesses in the liver. A total of 95 mg of docetaxel was infused intravenously. Before docetaxel administration, 8 mg of methyl predonine was routinely pretreated. One day after chemotherapy, the patient presented with a high-grade fever up to 39℃ and low blood pressure (80/55 mmHg). At that time, laboratory findings revealed a white blood cell count of 13,550/L, a red blood cell count of 2,420,000/L, a blood platelet count of 109,000/L, aspartate aminotransferase of 1,112 IU/L, alanine aminotransferase of 774 IU/L, and CRP of 4.6 mg/dl. Since he was diagnosed with septicemia unknown etiology, continuous dopamine infusion and broad-band antibiotics were started. The next day, blood chemistry examination revealed serious liver and renal dysfunction. Although sepsis was strongly suspected from leucocytosis and the high value of C-reactive protein, the origin of sepsis could not be identified. Despite intensive care including hemodialysis and respiratory support, the patient died 5 days against strong medical care after docetaxel administration. Blood bacterial culture revealed strongly positive E. coli. An autopsy was performed to check the cause of rapid multiple organ failure. There was no evidence of myelo-suppression by sequential chemotherapy from the result of bone marrow histology. Residual lymph node metastases from gastric cancer were histologically confirmed. Multiple occult liver abscesses which could not identified macroscopically were diagnosed by the histological examine (). They consisted of gram-negative rods and fungi (). Therefore, we concluded that fatal E. coli septicemia had been induced from multiple occult liver abscesses as a result of immuno compromised host induced by anticancer drug treatment.