title: Severe cardiotoxicity during 5-fluorouracil chemotherapy: a case and literature report.
abstract: The chemotherapeutic agent 5-fluorouracil (5-FU) is a widely accepted part of many cancer treatment protocols. Its cardiotoxic potential is known, but considered uncommon and usually not life threatening, although some cases of severe cardiotoxicity related to 5-FU have been reported. The pathogenesis of cardiotoxicity caused by 5-FU is not clear. We report a case of sudden onset of severe cardiac failure, without ischemic symptoms or signs, during 5-FU treatment with serious consequences, in a previously healthy 23-year-old patient with squamous cell carcinoma of the tongue. Endomyocardial biopsy showed proliferation of the sarcoplasmic reticulum with marked vacuolization, similar to that found with doxorubicin cardiotoxicity. Because 5-FU cardiotoxicity is unpredictable and can have potentially fatal consequences, it requires, in our opinion, further clarification. With this well-documented case, including an endomyocardial biopsy, we hope to encourage additional efforts to investigate the pathophysiologic mechanisms of 5-FU cardiotoxicity.
authors.affiliation: Rush Cancer Institute, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
authors.forename: C
authors.initials: C
authors.lastname: Kuropkat
authors.forename: K
authors.initials: K
authors.lastname: Griem
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.forename: E R
authors.initials: ER
authors.lastname: Rodriguez
authors.forename: J
authors.initials: J
authors.lastname: Hutchinson
authors.forename: S G
authors.initials: SG
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy*; D005472:Fluorouracil / Q000009:adverse effects*; D006331:Heart Diseases / Q000139:chemically induced; D006801:Humans; D008297:Male; D014062:Tongue Neoplasms / Q000188:drug therapy*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil