5-fluorouracil-induced coronary vasospasm.
BACKGROUND
Cardiotoxicity is a rare but well-documented adverse effect of 5-fluorouracil (5-FU). The underlying cause of this side effect of 5-FU is uncertain.


METHODS
We present a case report of a 63-year-old man treated for metastatic colon cancer who experienced chest pain while being treated with the FOLFIRI regimen. This case report documents coronary artery spasm on catheterization observed with the continuous infusion of 5-FU.


RESULTS
Cardiac catheterization obtained within 36 hours of the onset of chest pain revealed marked coronary vasospasm in the obtuse marginal coronary artery and a right coronary artery with a critical obstructive atherosclerotic plaque. Electrocardiogram revealed the myocardium area associated with the event was diffuse rather than localized to the right coronary artery.


CONCLUSIONS
This observation supports the vasospastic hypothesis for 5-FU-induced angina. Although rare, this type of cardiotoxicity with 5-FU is a potentially lethal side effect. Therapy with 5-FU should be discontinued and patients should be promptly treated.
Shoemaker
Laura K
LK
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. laurakshoemaker@yahoo.com
Arora
Umesh
U
Rocha Lima
Caio M
CM
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D006328:Cardiac Catheterization; D003110:Colonic Neoplasms / Q000473:pathology / Q000628:therapy; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D004562:Electrocardiography; D005472:Fluorouracil / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil