Simultaneous Cardiotoxicity and Neurotoxicity Associated with 5-fluorouracil Containing Chemotherapy: A Case Report and Literature Review

Justina Ray¹, Abdullah Mahmood¹, Muhammad Dogar¹, Junjing Guo¹, Felix Nwamaghinna¹, Louis Salciccioli¹ and Samy I. McFarlane^1,

¹Department of Medicine, SUNY-Downstate Health Science University, 450 Clarkson Avenue, Brooklyn, New York 11203, USA

Cite this paper

Justina Ray, Abdullah Mahmood, Muhammad Dogar, Junjing Guo, Felix Nwamaghinna, Louis Salciccioli and Samy I. McFarlane. Simultaneous Cardiotoxicity and Neurotoxicity Associated with 5-fluorouracil Containing Chemotherapy: A Case Report and Literature Review. American Journal of Medical Case Reports. 2020; 8(3):73-75. doi: 10.12691/AJMCR-8-3-2

Abstract

We present a case of simultaneous cardiotoxicity and stroke-like neurotoxicity in a patient treated with FOLFOX, a 5-Fluorouracil (5-FU)-containing chemotherapy regimen. Within hours of FOLFOX infusion, the patient began to exhibit signs and symptoms of myocardial ischemia and stroke mimic. Coronary vasoconstriction and vasospasm is a known mechanism of 5-FU-induced cardiotoxicity. 5-FU-induced neurotoxicity commonly presents as encephalopathy and is likely attributable to the accumulation of ammonia, a product of 5-FU metabolism. However, our patient presented with focal neurological signs and normal levels of ammonia. This suggests that 5-FU-induced vasospasm in the coronary arteries and cerebral vasculature is a likely cause of the simultaneous cardiac and neurological events we report here which have not been reported previously. Recognition of these toxicities as complications of 5-FU chemotherapy is crucial for the proper diagnosis and treatment of patients.

Keywords

FOLFOX, 5-fluorouracil, 5-FU, chemotherapy, cardiotoxicity, neurotoxicity

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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