title: 5-Fluorouracil-induced vasculitic injury manifesting as a multiorgan dysfunction in a patient with esophageal carcinoma.
abstract: 5-Fluorouracil (5-FU) is an active chemoetheraputic agent in many malignancies, used both in the curative and metastatic setting. Therefore, the side effect profile of 5-FU is well-described and recognized. Here, we present a case of a 28-year-old male, who received 5-FU and carboplatin concurrently, with radiation, for esophageal carcinoma. On Day 3 of his 5-FU infusion, he developed simultaneous cardiac arrhythmias, renal dysfunction, and aphasia. Magnetic resonance imaging (MRI) of his brain revealed acute demyelination of the white matter corresponding to diffusion restriction, pointing toward a small vessel injury. The 5-FU infusion was promptly discontinued and stress dose steroids were administered. The patient's symptoms resolved rapidly with no residual effects. We believe this is the first case of multisystem, small-vessel, vasculopathy secondary to 5-FU. Early recognition and prompt discontinuation of the offending drug is essential for resolution of symptoms. Steroids, with their anti-inflammatory effects can aid in rapid recovery.
authors.forename: Mohammad Faizan
authors.initials: MF
authors.lastname: Zahid
authors.forename: Nehal
authors.initials: N
authors.lastname: Masood
authors.affiliation: Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Munira
authors.initials: M
authors.lastname: Shabbir-Moosajee
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D003711:Demyelinating Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D013256:Steroids / Q000008:administration & dosage
chemical_list: D013256:Steroids; D016190:Carboplatin; D005472:Fluorouracil