title: Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer.
abstract: A 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m(2) per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21(st) course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4-6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC. changry77@gmail.com
authors.forename: Rei-Yeuh
authors.initials: RY
authors.lastname: Chang
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Lee
authors.forename: Chung-Ben
authors.initials: CB
authors.lastname: Kan
authors.forename: Wei-Pang
authors.initials: WP
authors.lastname: Hsu
authors.forename: Pei-Ching
authors.initials: PC
authors.lastname: Hsiao
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects; D008133:Long QT Syndrome / Q000139:chemically induced*; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000188:drug therapy*; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil
keywords: coronary vasospasm; hypersensitivity; long QT syndrome; oxaliplatin; torsades de pointes