Ann Surg Treat Res.  2016 Mar;90(3):179-182. 10.4174/astr.2016.90.3.179.

Acute hyperammonemic encephalopathy after 5-fluorouracil based chemotherapy

• Yi HJ
• Hong KS
• Moon N
• Chung SS
• Lee RA
• Kim KH

• KMID: 2155052
• DOI: http://doi.org/10.4174/astr.2016.90.3.179

Abstract

5-Fluorouracil (5-FU) based chemotherapy has been commonly used to treat metastatic or advanced colon cancer as an adjuvant chemotherapy. Although the side effects of 5-FU such as gastrointestinal problems and neutropenia and thrombocytopenia are common, not many cases of 5-FU related encephalopathy are reported. Hyperammonemic encephalopathy is a rare central nervous system toxicity following 5-FU chemotherapy manifesting as altered mental status with elevated ammonia levels with no radiologic abnormality. We report one case of 5-FU induced hyperammonemic encephalopathy occurring after Folfox4 (oxaliplatin, folinic acid and 5-fluorouracil) chemotherapy in a colon cancer patient who presented with confused mental status soon after the chemotherapy and review the 5-FU related encephalopathy.

Keyword

Colorectal neoplasma; 5-Fluorouracil; Hyperammonemia; Metabolic brain diseases

MeSH Terms

Ammonia
Brain Diseases, Metabolic
Central Nervous System
Chemotherapy, Adjuvant
Colonic Neoplasms
Drug Therapy*
Fluorouracil*
Humans
Hyperammonemia
Leucovorin
Neutropenia
Thrombocytopenia
Ammonia
Fluorouracil
Leucovorin

Figure

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  Fig. 1 Chest x-ray taken before chemotherapy; there was no abnormality.

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  Fig. 2 Abdomen-pelvic CT scan taken before operation; neither liver nor kidney lesion was found.

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  Fig. 3 Patient's brain CT scan (A) and diffusion weighted MRI (B) did not show any abnormal finding.

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