Title:Cyclophosphamide Toxicity in Pediatric Nephrotic Syndrome Patient: A
Case Report and Literature Review
Volume: 19
Issue: 4
Author(s): Soumya Patil, Mahantesh V Patil, Apoorva Bagalkotkar and Shashikala Wali*
Affiliation:
- Department of Pharmacy Practice, KLE College of Pharmacy, A Constituent Unit of KLE Academy of Higher Education
and Research (KAHER), Belgaum-590010, Karnataka, India
Keywords:
Cyclophosphamide, medication error, overdose, patient education, prednisolone, steroid resistant nephrotic syndrome.
Abstract:
Background: Primary membranous nephropathy is a rare presentation in children. Patients
unresponsive to steroids and experiencing frequent relapse are considered steroid-resistant.
They often require complex treatment regimens consisting of immunosuppressants like cyclophosphamide,
tacrolimus, and cyclosporin A.
Case: In the present case, a 5-year-old child was suffering from steroid-resistant nephrotic syndrome
for the past 10 months. He was initially treated with prednisolone 20mg but was subsequently
found to be steroid-resistant. A renal biopsy revealed primary podocytopathy with immunocomplex
deposits in podocyte tissues, suggesting primary membranous nephropathy as the
cause of SRNS (steroid-resistant nephrotic syndrome). Cyclophosphamide 25mg twice daily was
added to the treatment plan since the child did not tolerate tacrolimus therapy. During a subsequent
follow-up, the physician reduced the cyclophosphamide 25mg dose to once a day, but parents
misinterpreted this, and the child received a larger dose, cyclophosphamide 25mg, four
times a day for 20 days. This resulted in cyclophosphamide toxicity-induced neutropenia, alopecia
and posing the child at greater risk of sepsis.
Conclusion: Nephrotic syndrome is a chronic disease that demands extensive treatment plans
and strict monitoring. Medication errors are common among parents or caregivers of pediatric
patients. This case is a take-home message emphasizing the significance of patient-centered
communication in preventing medication errors. A clinical pharmacist can aid in conveying simple
and unambiguous information to parents or caregivers.
