title: Rapid Extracorporeal Membrane Oxygenation Overcomes Fulminant Myocarditis Induced by 5‑Fluorouracil.
abstract: Fulminant myocarditis is a rare but potentially life-threatening illness caused by 5-fluorouracil cardiotoxicity. Data supporting the use of extracorporeal membrane oxygenation for the treatment of fulminant myocarditis are limited. A 49-year-old, previously healthy white man, recently diagnosed with anal squamous cell carcinoma, developed severe chest pain hours after completing his first 96-hour intravenous 5-fluorouracil treatment. Over a period of 3 days from onset of symptoms, the patient developed cardiogenic shock secondary to fulminant myocarditis induced by 5-fluorouracil cardiotoxicity. This required emergency initiation of extracorporeal membrane oxygenation. The patient's systolic function recovered by day 5, and on the 17th day he was discharged in hemodynamically stable condition, without symptoms of heart failure. This case shows the importance of prompt recognition of cardiogenic shock secondary to 5-fluorouracil-induced myocarditis and how the immediate initiation of extracorporeal membrane oxygenation can restore adequate tissue perfusion, leading to myocardial recovery and ultimately the survival of the patient.
authors.forename: Alok R
authors.initials: AR
authors.lastname: Amraotkar
authors.forename: Ajay
authors.initials: A
authors.lastname: Pachika
authors.forename: Kendra J
authors.initials: KJ
authors.lastname: Grubb
authors.forename: Andrew P
authors.initials: AP
authors.lastname: DeFilippis
mesh_terms: D000208:Acute Disease; D001005:Anus Neoplasms / Q000188:drug therapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005472:Fluorouracil / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D005472:Fluorouracil
keywords: Antineoplastic agents/cardiotoxicity; ECMO; colorectal neoplasms/drug therapy; fluorouracil/adverse effects/therapeutic use/toxicity; male; middle aged; myocarditis/chemically induced; treatment outcome