title: Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report.
abstract: BACKGROUND
  High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen.
  
  
  METHODS
  We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5.
  
  
  CONCLUSIONS
  Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.
authors.affiliation: Department of Medicine, Nassau University Medical Cite Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sokolova
authors.affiliation: Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA. onyeec@deptofmed.arizona.edu.
authors.forename: Onyee
authors.identifier: http://orcid.org/0000-0003-2872-1961
authors.initials: O
authors.lastname: Chan
authors.affiliation: Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.
authors.forename: Waqas
authors.initials: W
authors.lastname: Ullah
authors.affiliation: Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.
authors.forename: Auon Abbas
authors.initials: AA
authors.lastname: Hamdani
authors.affiliation: Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.|Department of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Anwer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin; D005047:Etoposide; D005440:Fluid Therapy / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007069:Ifosfamide; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D017239:Paclitaxel; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000628:therapy; D013736:Testicular Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D007069:Ifosfamide
keywords: Carboplatin; Etoposide; Rhabdomyolysis; TI-CE chemotherapy; Testicular cancer