Intermediate dose 5-fluorouracil-induced encephalopathy.
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| Abstract |
As an acute neurotoxicity, high dose 5-fluorouracil (5-FU)-induced encephalopathy is well-known, but encephalopathy associated with lower dose is rarely reported. Here, we report a case of a male with anal cancer who was treated with 5-FU 1000 mg/m(2), continuous infusion for 5 days q4 weeks. At the second and the fourth cycles of chemotherapy, sudden confusion, cognitive dysfunction and disorientation occurred during 5-FU infusion. They were accompanied by hyperammonemia in the absence of focal neurological deficits or structural abnormalities. These symptoms completely disappeared and the serum ammonia level returned to normal after discontinuation of 5-FU and conservative care. In order to investigate a possible deficit of dihydropyrimidine dehydrogenase (DPD), we checked its mRNA level before and after treatment using real-time PCR. The patient's pre-treatment level was 80% compared with reference group, and it was elevated up to 187% of initial after 5-FU treatment, implying that that his encephalopathy may be 5-FU catabolite type rather than DPD deficiency. In conclusion, we report that encephalopathy can develop even with the dose of 5-FU lower than ever reported, and it should be considered as a differential diagnosis for proper management.
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| Authors | Yeon-A Kim, Hyun Cheol Chung, Hye Jin Choi, Sun Young Rha, Jin Sil Seong, Hei-Cheul Jeung |
| Journal | Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 36 Issue 1 Pg. 55-9 (Jan 2006) ISSN: 0368-2811 [Print] England |
| PMID | 16436463 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't) |
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