članak: 1 od 1  
Vojnosanitetski pregled
2009, vol. 66, br. 10, str. 833-839
jezik rada: srpski
prikaz slučaja
doi:10.2298/VSP0910833M

Nemogućnost tretmana inoperabilne multicistične ehinokokoze jetre zbog neželjenih reakcija na antihelmintike
aVojnomedicinska akademija
bVisoka strukovna medicinska škola 'Milutin Milanković', Beograd
cUniverzitet u Prištini (Kosovska Mitrovica), Medicinski fakultet

e-adresa: drmikic@gmail.com

Sažetak

Uvod. U nekim slučajevima multicistične forme ehinokokne bolesti jetre savremeno lečenje cistične ehinokokoze ne dovodi do željenih rezultata u pogledu konačnog ishoda lečenja. Prikaz slučaja. Kod bolesnice stare 27 godina, zbog bolova u trbuhu maja 2005. godine urađena je kompjuterizovana tomografija abdomena kojom je registrovano preko 20 ehinokoknih cisti u oba režnja jetre, prečnika do 6,7 cm. U laboratorijskim nalazima vrednost eozinofila iznosila je 6,8%, gama globulina 29,9%, imunoglobulina E 29 600 IU/mL, a indirektna hemaglutinacija na ehinokokozu 1 : 8 196. Lečenje je započeto decembra iste godine kontinuiranom primenom albendazola u dozi od 800 mg (14,5 mg/kg telesne težine) dnevno, ali je zbog visokih vrednosti serumskih transaminaza nakon dva meseca prekinuto. Krajem 2006. najveća cista u levom režnju jetre bila je prečnika 5,7 cm, a u desnom 4,1 cm, obe sa odlubljenom germinativnom membranom. Šest meseci kasnije u terapiju je uključen prazikvantel u dozi od 2 500 mg (45,3 mg/kg telesne težine) dnevno, ali je zbog razvoja egzantema posle osam dana lečenje prekinuto. Kompjuterizovana tomografija abdomena urađena februara 2008. pokazala je da u jetri postoji veliki broj ehinokoknih cisti najvećih dimenzija 3,5 cm, od kojih su neke imale kalcifikovan zid. Za nastavak lečenja nijedan od preostalih modaliteta terapije ehinokokne bolesti nije se mogao primeniti. Zaključak. Prikazani slučaj potvrđuje da je za lečenje nekih formi cistične ehinokokoze jedina terapijska opcija medikamentna terapija. Benzimidazol-karbamati (albendazol, mebendazol) i prazikvantel jedini su efikasni antihelmintici na raspolaganju, pa u slučaju njihove obustave zbog ispoljavanja ozbiljnih neželjenih efekata, dalje lečenje bolesnika sa cističnom ehinokokozom jetre postaje nemoguće. Zbog toga se nameće potreba za iznalaženjem novih i efikasnijih lekova za lečenje ehinokokne bolesti.

Ključne reči

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