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

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